Provider Demographics
NPI:1376231142
Name:LENZ, ALYSON MARIE
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:MARIE
Last Name:LENZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15340 BEALFRED DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1711
Mailing Address - Country:US
Mailing Address - Phone:810-407-1724
Mailing Address - Fax:
Practice Address - Street 1:15340 BEALFRED DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1711
Practice Address - Country:US
Practice Address - Phone:810-407-1724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program