MEDICARE: MS. SUE ANN LAZAR MSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	28047856A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326033119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUE ANN LAZAR MSN

Provider Business Mailing Address
First Line	:	2970 BELLE MAISON DR
Second Line	:
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-8901
Country	:	US
Telephone Number	:	317-769-5089
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 W 86TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2203
Country	:	US
Telephone Number	:	317-253-6427
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	01/13/2009

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