Provider Demographics
NPI:1083304497
Name:LANZ, MARK J
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:LANZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 KEY LARGO DR APT 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-5308
Mailing Address - Country:US
Mailing Address - Phone:702-731-1838
Mailing Address - Fax:
Practice Address - Street 1:3251 KEY LARGO DR APT 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-5308
Practice Address - Country:US
Practice Address - Phone:702-731-1838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider