MEDICARE: CORINE BELLE LAZARO CNP

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	363L00000X	Nurse Practitioner	CNP-01979	NM

General Provider Information

NPI Number	:	1710232251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORINE BELLE LAZARO CNP

Provider Business Mailing Address
First Line	:	1131 MALL DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8191
Country	:	US
Telephone Number	:	575-522-7676
Fax Number	:	575-522-8121

Provider Business Practice Location Address
First Line	:	1131 MALL DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8191
Country	:	US
Telephone Number	:	575-522-7676
Fax Number	:	575-522-8121

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

Provider Enumeration Date	:	07/20/2012
Last Update Date	:	07/20/2012

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