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General NPI Number Information
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NPI Number | 1689747974
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Entity Type | Individual
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Provider Name | MARY PATRICIA LAZAREK CRNP
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Gender | Female
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 2424 REEDIE DR
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City | WHEATON
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State | MD
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Zip | 20902-4624
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Country | US
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Telephone | 301-962-6173
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 E JEFFERSON ST KAISER PERMANENTE MEDICARE ENROLLMENT
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City | ROCKVILLE
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State | MD
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Zip | 20852-4908
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Country | US
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Telephone | 301-816-7405
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R103005
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024066457
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License Number State | VA
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