Provider Demographics
NPI:1154023950
Name:LAZARO, NICHOLAS JOHN
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOHN
Last Name:LAZARO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2974 VALLEYVIEW DR # 2974
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-2074
Mailing Address - Country:US
Mailing Address - Phone:614-772-1872
Mailing Address - Fax:
Practice Address - Street 1:2974 VALLEYVIEW DR # 2974
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2074
Practice Address - Country:US
Practice Address - Phone:614-772-1872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide