Provider Demographics
NPI:1093987588
Name:KANZLER, LAUREN KING (CCN)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:KING
Last Name:KANZLER
Suffix:
Gender:F
Credentials:CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6887 W LIGHTNING RIDGE PLACE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-8710
Mailing Address - Country:US
Mailing Address - Phone:520-743-2336
Mailing Address - Fax:
Practice Address - Street 1:2550 E FORT LOWELL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716
Practice Address - Country:US
Practice Address - Phone:520-743-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3973133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist