Provider Demographics
NPI:1003161548
Name:LENZ, ALLYSON DIBERT (BSN, RN, MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:DIBERT
Last Name:LENZ
Suffix:
Gender:F
Credentials:BSN, RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15612 REEDS ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2162
Mailing Address - Country:US
Mailing Address - Phone:405-802-8000
Mailing Address - Fax:
Practice Address - Street 1:10730 NALL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211
Practice Address - Country:US
Practice Address - Phone:913-945-9837
Practice Address - Fax:913-945-9838
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR190962363LF0000X
KS5377136062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD451LMedicare PIN
279148ZCSVMedicare PIN
MDCD8143Medicare PIN