Provider Demographics
NPI:1770101446
Name:LAZZARI, CYNTHIA JANE (RN)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JANE
Last Name:LAZZARI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12413 DETOUR RD
Mailing Address - Street 2:
Mailing Address - City:KEYMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21757-8821
Mailing Address - Country:US
Mailing Address - Phone:301-367-9818
Mailing Address - Fax:
Practice Address - Street 1:7085 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-5414
Practice Address - Country:US
Practice Address - Phone:410-313-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR138981163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty