Individual
MS. VICTORIA L LAZARETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 FODEN RD STE 203, SOUTH PORTLAND, ME 04106-2327
(207) 523-3900
Mailing address
100 GANNETT DR STE C, SOUTH PORTLAND, ME 04106-5900
(207) 347-2947
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN224447
MA
363LA2200X
Adult Health Nurse Practitioner
Primary
CNP201196
ME
363LA2200X
Adult Health Nurse Practitioner
RN224447
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0375900
—
MA
Enumeration date
02/16/2006
Last updated
03/04/2026
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