Provider Demographics
NPI:1508986613
Name:LAZAROWICZ, CAROLYN A
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:LAZAROWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-4192
Mailing Address - Country:US
Mailing Address - Phone:989-746-9633
Mailing Address - Fax:989-746-9634
Practice Address - Street 1:2480 SLOAN RD
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415-8934
Practice Address - Country:US
Practice Address - Phone:989-746-9633
Practice Address - Fax:989-746-9634
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704184286163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult