Provider Demographics
NPI:1033341995
Name:LANZA, DEBRA J (NP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:LANZA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:J
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:VASCULAR SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-9160
Mailing Address - Fax:414-805-9170
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:VASCULAR SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-9160
Practice Address - Fax:414-805-9170
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI82844363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1033341995Medicaid
WI1033341995Medicaid
WI736011537Medicare PIN