Provider Demographics
NPI:1336782093
Name:LAZAR, MIRANDA (CNP)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:LAZAR
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12089 LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:SHARONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45241-1703
Mailing Address - Country:US
Mailing Address - Phone:513-847-6778
Mailing Address - Fax:
Practice Address - Street 1:12089 LEBANON RD
Practice Address - Street 2:
Practice Address - City:SHARONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45241-1703
Practice Address - Country:US
Practice Address - Phone:513-847-6778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.427746163W00000X
OHAPRN.CNP.024877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse