Basic Information
Provider Information
NPI: 1346799988
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LANZARO
FirstName: ELIZABETH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 930 N 4TH ST
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891011001
CountryCode: US
TelephoneNumber: 7023834044
FaxNumber:  
Practice Location
Address1: 1711 WHITNEY MESA DR
Address2:  
City: HENDERSON
State: NV
PostalCode: 890142080
CountryCode: US
TelephoneNumber: 7023852090
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/23/2016
LastUpdateDate: 09/23/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN08496NVY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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