Provider Demographics
NPI:1558909978
Name:LAZAR, RUXANDRA MARIA (DNP)
Entity Type:Individual
Prefix:MRS
First Name:RUXANDRA
Middle Name:MARIA
Last Name:LAZAR
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5285 ANTHONY WAYNE DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3947
Mailing Address - Country:US
Mailing Address - Phone:313-577-5041
Mailing Address - Fax:
Practice Address - Street 1:5285 ANTHONY WAYNE DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3947
Practice Address - Country:US
Practice Address - Phone:313-577-5041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704308275363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily