Provider Demographics
NPI:1558019257
Name:LAZARUS WIKNIK, DEYON M
Entity Type:Individual
Prefix:MRS
First Name:DEYON
Middle Name:M
Last Name:LAZARUS WIKNIK
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DEYON
Other - Middle Name:M
Other - Last Name:LAZARUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11 TROY ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1757
Mailing Address - Country:US
Mailing Address - Phone:860-794-4534
Mailing Address - Fax:
Practice Address - Street 1:11 TROY ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1757
Practice Address - Country:US
Practice Address - Phone:860-794-4534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-13
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health