Provider Demographics
NPI:1760811996
Name:LAZARZ, ASHLEY (RD, RDN)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:LAZARZ
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WASHINGTON ST
Mailing Address - Street 2:APT. 2A
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3107
Mailing Address - Country:US
Mailing Address - Phone:603-650-5973
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-5973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0580133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered