Individual
AUTUMN LAZARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2032 S 17TH ST STE 101, WILMINGTON, NC 28401-6678
(910) 763-3738
(910) 763-0454
Mailing address
2032 S 17TH ST STE 101, WILMINGTON, NC 28401-6678
(910) 763-3738
(910) 763-0454
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
7182
MA
363A00000X
Physician Assistant
Primary
0010-12035
NC
363A00000X
Physician Assistant
4474
CT
Other
Enumeration date
06/11/2019
Last updated
04/01/2022
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