Provider Demographics
NPI:1215968714
Name:LAZARUS, SUE T (CNM)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:T
Last Name:LAZARUS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803
Mailing Address - Country:US
Mailing Address - Phone:417-347-8660
Mailing Address - Fax:417-347-8691
Practice Address - Street 1:1532 W 32ND ST
Practice Address - Street 2:STE 201
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1607
Practice Address - Country:US
Practice Address - Phone:417-347-8660
Practice Address - Fax:417-347-8691
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-64037176B00000X
MO2003031877176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO196105OtherANTHEM
OK200020120BMedicaid
KS200251050BMedicaid
MO259261105Medicaid
KS200251050AMedicaid
P00116412OtherRR MEDICARE
MO259261105Medicaid
OK200020120BMedicaid