Provider Demographics
NPI:1477844603
Name:LANCZ, MARNIE ANNE (M ED)
Entity Type:Individual
Prefix:
First Name:MARNIE
Middle Name:ANNE
Last Name:LANCZ
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7065 W ANN RD # 671
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3865
Mailing Address - Country:US
Mailing Address - Phone:702-556-3132
Mailing Address - Fax:702-425-3132
Practice Address - Street 1:7495 W AZURE DR STE 254
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-4416
Practice Address - Country:US
Practice Address - Phone:702-556-3132
Practice Address - Fax:702-425-2787
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0000077260171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator