Provider Demographics
NPI:1689747974
Name:LAZAREK, MARY PATRICIA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:PATRICIA
Last Name:LAZAREK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:P
Other - Last Name:SHEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-7405
Mailing Address - Fax:
Practice Address - Street 1:2424 REEDIE DR
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-4624
Practice Address - Country:US
Practice Address - Phone:301-962-6173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR103005363LF0000X
VA0024066457363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P93211Medicare UPIN
012230K92Medicare ID - Type Unspecified