Basic Information
| Provider Information | |||||||||
| NPI: | 1902965122 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAZAR | ||||||||
| FirstName: | LYNDA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 811 N HARRISVILLE RD | ||||||||
| Address2: | |||||||||
| City: | HARRISVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844043537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013991818 | ||||||||
| FaxNumber: | 8017828412 | ||||||||
| Practice Location | |||||||||
| Address1: | 811 N HARRISVILLE RD | ||||||||
| Address2: | |||||||||
| City: | HARRISVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844043537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013991818 | ||||||||
| FaxNumber: | 8017828412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NP12270 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 7637067-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1952432635 | 05 | UT | MEDICAID |