Provider Demographics
NPI:1134910839
Name:LAZARUS, SAMUEL A I
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:A
Last Name:LAZARUS
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12266 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1320
Mailing Address - Country:US
Mailing Address - Phone:406-298-0938
Mailing Address - Fax:
Practice Address - Street 1:12266 CHARLES ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1320
Practice Address - Country:US
Practice Address - Phone:406-298-0938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH13128240372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider