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General NPI Number Information
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NPI Number | 1780953281
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Entity Type | Individual
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Provider Name | LAURIE DAZAROW
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Gender | Female
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Dates
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Enumeration Date | 12/29/2011
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Last Update Date | 12/29/2011
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Provider Practice Location Address
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Address Line | 2215 FULLER RD
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City | ANN ARBOR
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State | MI
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Zip | 48105-2303
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Country | US
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Telephone | 734-845-3762
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Fax |
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Provider Business Mailing Address
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Address Line | 21 SLATESTONE DR
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City | SAGINAW
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State | MI
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Zip | 48603-2890
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Country | US
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Telephone |
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 4704117485
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License Number State | MI
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