Provider Demographics
NPI:1417926155
Name:PANCRATZ, LOIS (ARNP)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:
Last Name:PANCRATZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6388
Mailing Address - Country:US
Mailing Address - Phone:563-582-1881
Mailing Address - Fax:
Practice Address - Street 1:350 N GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6388
Practice Address - Country:US
Practice Address - Phone:563-582-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA045352363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0430553Medicaid
49177Medicare ID - Type Unspecified
R78586Medicare UPIN