MEDICARE: MRS. KERRY COLLINS LAZEWSKI NP

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	363LP0200X	Pediatric Nurse Practitioner	209005522	IL

General Provider Information

NPI Number	:	1760413637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KERRY COLLINS LAZEWSKI NP

Provider Business Mailing Address
First Line	:	220 DES PLAINES AVE
Second Line	:	UNIT E
City	:	FOREST PARK
State	:	IL
Zip	:	60130-1227
Country	:	US
Telephone Number	:	708-771-2747
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2730
Country	:	US
Telephone Number	:	800-543-7365
Fax Number	:

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	04/25/2022

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