Provider Demographics
NPI:1275315384
Name:LORENTZ, BRENDA MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:LORENTZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:MARIE
Other - Last Name:KIMMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50195 COUNTY HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:MN
Mailing Address - Zip Code:56567-9124
Mailing Address - Country:US
Mailing Address - Phone:218-371-6000
Mailing Address - Fax:
Practice Address - Street 1:15620 EDGEWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56401-6984
Practice Address - Country:US
Practice Address - Phone:218-270-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10688363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner