Provider Demographics
NPI:1386689099
Name:LOTZ, ELIZABETH RUTH (RFM, CFM)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:RUTH
Last Name:LOTZ
Suffix:
Gender:F
Credentials:RFM, CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 S 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-5709
Mailing Address - Country:US
Mailing Address - Phone:715-845-2800
Mailing Address - Fax:715-845-2855
Practice Address - Street 1:1108 S 17TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5709
Practice Address - Country:US
Practice Address - Phone:715-845-2800
Practice Address - Fax:715-845-2855
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WICFM00825174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41782800Medicaid
WI0251680002Medicare ID - Type UnspecifiedADMINASTAR FEDERAL NUMBER