Provider Demographics
NPI:1326033119
Name:LAZAR, SUE ANN (MSN)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:ANN
Last Name:LAZAR
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 BELLE MAISON DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8901
Mailing Address - Country:US
Mailing Address - Phone:317-769-5089
Mailing Address - Fax:
Practice Address - Street 1:1225 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2203
Practice Address - Country:US
Practice Address - Phone:317-253-6427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28047856A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200188230AMedicaid
IN232230FMedicare UPIN
IN200188230AMedicaid