Provider Demographics
NPI:1336837814
Name:LAZARO, CHELSEA CHARITY (NP)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:CHARITY
Last Name:LAZARO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 OAK GROVE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6805
Mailing Address - Country:US
Mailing Address - Phone:601-572-1893
Mailing Address - Fax:
Practice Address - Street 1:300 NISSAN DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-8562
Practice Address - Country:US
Practice Address - Phone:601-855-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905823363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner