Provider Demographics
NPI:1578089710
Name:LAZARO, KAYLEE BRIANNA (RN)
Entity Type:Individual
Prefix:MRS
First Name:KAYLEE
Middle Name:BRIANNA
Last Name:LAZARO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:BRIANNA
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:630 BARNCLE WAY, SUITE A
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611
Mailing Address - Country:US
Mailing Address - Phone:907-335-3400
Mailing Address - Fax:
Practice Address - Street 1:630 BARNACLE WAY STE A
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7732
Practice Address - Country:US
Practice Address - Phone:907-335-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101152163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health