Provider Demographics
NPI:1821677014
Name:LAZEAR, MICHAEL GREGORY (RN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GREGORY
Last Name:LAZEAR
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MCGILL RD
Mailing Address - Street 2:
Mailing Address - City:VINCENT
Mailing Address - State:OH
Mailing Address - Zip Code:45784-5145
Mailing Address - Country:US
Mailing Address - Phone:740-525-2908
Mailing Address - Fax:
Practice Address - Street 1:301 GREENE ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3134
Practice Address - Country:US
Practice Address - Phone:740-376-0769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH333476163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency