Provider Demographics
NPI:1265685002
Name:LAZAR, JALANA N (CNM)
Entity Type:Individual
Prefix:
First Name:JALANA
Middle Name:N
Last Name:LAZAR
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 1:9000 N MAIN ST
Mailing Address - Street 2:SUITE 234
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1180
Mailing Address - Country:US
Mailing Address - Phone:937-277-8988
Mailing Address - Fax:937-832-2421
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:SUITE 234
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1180
Practice Address - Country:US
Practice Address - Phone:937-277-8988
Practice Address - Fax:937-832-2421
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM10353367A00000X
OHNP10479363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2905860Medicaid