Provider Demographics
NPI:1093724874
Name:LORENZ, DENISE A (NP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:LORENZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:A
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:23101 LAKE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2801
Mailing Address - Country:US
Mailing Address - Phone:949-716-9021
Mailing Address - Fax:949-861-6810
Practice Address - Street 1:23101 LAKE CENTER DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2801
Practice Address - Country:US
Practice Address - Phone:949-716-9021
Practice Address - Fax:949-861-6810
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA281288363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP0164370OtherBLUE SHIELD OF CA
B077OtherCHAMPUS
WNP16437AMedicare PIN