Provider Demographics
NPI:1063487452
Name:LORENZ, MARLENE B (NP)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:B
Last Name:LORENZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6160 KEMPSVILLE CIR
Mailing Address - Street 2:STE 325A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3933
Mailing Address - Country:US
Mailing Address - Phone:757-354-2885
Mailing Address - Fax:757-917-5141
Practice Address - Street 1:110 KINGSLEY LN
Practice Address - Street 2:SUITE 312
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4614
Practice Address - Country:US
Practice Address - Phone:757-354-2885
Practice Address - Fax:757-889-5742
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0001140571163W00000X
VA0024164363P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA41686NOtherSENTARA/OPTIMA
VA7780257Medicaid
VA41686NOtherSENTARA/OPTIMA
500000855Medicare PIN