Provider Demographics
NPI:1225464274
Name:WENTZEL, LORI IRENE (RN, PHN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:IRENE
Last Name:WENTZEL
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:SLAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:56172-4500
Mailing Address - Country:US
Mailing Address - Phone:507-836-6486
Mailing Address - Fax:
Practice Address - Street 1:3001 MAPLE RD
Practice Address - Street 2:
Practice Address - City:SLAYTON
Practice Address - State:MN
Practice Address - Zip Code:56172-4500
Practice Address - Country:US
Practice Address - Phone:507-836-6486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 186094-8163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse