Provider Demographics
NPI:1164123188
Name:LAZAREK, JEAN (RN)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:LAZAREK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 W 2ND ST STE 2
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3812
Mailing Address - Country:US
Mailing Address - Phone:315-342-4489
Mailing Address - Fax:
Practice Address - Street 1:283 W 2ND ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3812
Practice Address - Country:US
Practice Address - Phone:315-342-4489
Practice Address - Fax:315-343-3281
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY525612163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)