Provider Demographics
NPI:1508549544
Name:LAZAR, AMBER (RD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LAZAR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 DRAYTON DRIVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042
Mailing Address - Country:US
Mailing Address - Phone:717-658-2780
Mailing Address - Fax:
Practice Address - Street 1:FORT CAMPBELL
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KS
Practice Address - Zip Code:42223
Practice Address - Country:US
Practice Address - Phone:717-658-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN008009133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered