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General NPI Number Information
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NPI Number | 1710132972
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Entity Type | Organization
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Legal Business Name | THE PHYSICIAN & MIDWIFE COLLABORATIVE PRACTICE PC
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 4660 KENMORE AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22304-1313
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Country | US
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Telephone | 703-370-4300
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Fax | 703-370-0044
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Provider Business Mailing Address
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Address Line | 4660 KENMORE AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22304-1313
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Country | US
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Telephone | 703-370-4300
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Fax | 703-370-0044
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Authorized Official
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Title or Position | CERTIFIED NURSE MIDWIFE
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Name | MRS. JULIANN LAZZARO
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Credential | CNM
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Telephone | 716-912-2945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | 0024169729
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License Number State | VA
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