Provider Demographics
NPI:1891778239
Name:LAZAR, NELLIE RIENDEAU (CRNP)
Entity Type:Individual
Prefix:MS
First Name:NELLIE
Middle Name:RIENDEAU
Last Name:LAZAR
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:3535 MARKET ST. STE. 1371
Mailing Address - Street 2:CHOP ADOLESCENT INITIATIVE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5021
Mailing Address - Country:US
Mailing Address - Phone:215-590-3626
Mailing Address - Fax:215-590-0426
Practice Address - Street 1:3535 MARKET ST. STE. 1371
Practice Address - Street 2:CHOP ADOLESCENT INITIATIVE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5021
Practice Address - Country:US
Practice Address - Phone:215-590-3626
Practice Address - Fax:215-590-0426
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP008400363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024965980001Medicaid
1891778239OtherNPI