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General NPI Number Information
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NPI Number | 1871114645
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Entity Type | Individual
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Provider Name | LAZIA VAN WIERINGEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/02/2020
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 2320 FREEWAY DR
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City | MOUNT VERNON
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State | WA
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Zip | 98273-5445
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Country | US
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Telephone | 360-428-2550
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Fax | 360-428-6402
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Provider Business Mailing Address
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Address Line | 910 GLADSTONE ST APT 111
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City | BELLINGHAM
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State | WA
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Zip | 98229-6226
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Country | US
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Telephone | 425-367-9015
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.PA.61187952
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA61187952
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License Number State | WA
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