Provider Demographics
NPI:1326002684
Name:BARBARA LAZERUS CRNA MS
Entity Type:Organization
Organization Name:BARBARA LAZERUS CRNA MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAZERUS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:501-467-8061
Mailing Address - Street 1:13291 HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-7431
Mailing Address - Country:US
Mailing Address - Phone:501-771-4370
Mailing Address - Fax:501-327-9722
Practice Address - Street 1:1001 SCHNEIDER DR
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-4811
Practice Address - Country:US
Practice Address - Phone:501-337-4911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160257002Medicaid
AR5F117Medicare PIN