Provider Demographics
NPI:1306523337
Name:LAZEWSKI, RHIANNON MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:RHIANNON
Middle Name:MARIE
Last Name:LAZEWSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 BANYAN BLVD UNIT 408
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-4651
Mailing Address - Country:US
Mailing Address - Phone:412-526-6766
Mailing Address - Fax:
Practice Address - Street 1:1812 HWY 441N SUITE 310A
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE,
Practice Address - State:FL
Practice Address - Zip Code:34972
Practice Address - Country:US
Practice Address - Phone:863-357-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant