Provider Demographics
NPI:1902965122
Name:LAZAR, LYNDA B (APRN)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:B
Last Name:LAZAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 N HARRISVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84404-3537
Mailing Address - Country:US
Mailing Address - Phone:801-399-1818
Mailing Address - Fax:801-782-8412
Practice Address - Street 1:811 N HARRISVILLE RD
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:UT
Practice Address - Zip Code:84404-3537
Practice Address - Country:US
Practice Address - Phone:801-399-1818
Practice Address - Fax:801-782-8412
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP12270363L00000X
UT7637067-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1952432635Medicaid