# THE PHYSICIAN & MIDWIFE COLLABORATIVE PRACTICE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710132972
- **Authorized official:** MRS. JULIANN LAZZARO CNM (CERTIFIED NURSE MIDWIFE)
- **Authorized official phone:** (716) 912-2945

## Contact information

- **Practice address:** 4660 KENMORE AVE, ALEXANDRIA, VA 22304-1313
- **Practice address phone:** (703) 370-4300
- **Practice address fax:** (703) 370-0044
- **Mailing address:** 4660 KENMORE AVE, ALEXANDRIA, VA 22304-1313
- **Mailing address phone:** (703) 370-4300
- **Mailing address fax:** (703) 370-0044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LX0001X | Obstetrics & Gynecology Nurse Practitioner | 0024169729 | VA | Yes |

## Other

- **Enumeration date:** 12/01/2008
- **Last updated:** 01/25/2012