Provider Demographics
NPI:1346818697
Name:LAZ, KATRINA SANDRA (PA-C)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:SANDRA
Last Name:LAZ
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:627 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1085
Mailing Address - Country:US
Mailing Address - Phone:413-858-0000
Mailing Address - Fax:
Practice Address - Street 1:627 RANDALL RD
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-1085
Practice Address - Country:US
Practice Address - Phone:413-858-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant