Individual
AUDREY J LAZENBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
EMILE @ 42ND ST, OMAHA, NE 68198-0001
(402) 559-4186
(402) 559-6018
Mailing address
988102 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-8102
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
18693
AL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
23983
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000025160
BLUE CROSS
AL
05
—
000025160
—
AL
01
—
051530857
BLUE CROSS
AL
01
—
1595934
EMERGENCY LA MEDICAID
LA
01
—
220015991
RAILROAD MEDICARE
AL
01
—
E36147
VIVA
AL
Enumeration date
06/27/2006
Last updated
01/16/2019
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