Provider Demographics
NPI:1346591328
Name:REDWANTZ, LANCE LOUIS-JOHN (RD)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:LOUIS-JOHN
Last Name:REDWANTZ
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 JANES STREET
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601
Mailing Address - Country:US
Mailing Address - Phone:989-755-0316
Mailing Address - Fax:989-754-0674
Practice Address - Street 1:1522 JANES STREET
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601
Practice Address - Country:US
Practice Address - Phone:989-755-0316
Practice Address - Fax:989-754-0674
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
1063446133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered