Provider Demographics
NPI:1578845301
Name:LENZ, ROXANNE (ARNP)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:LENZ
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 1:129 8TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-2352
Mailing Address - Country:US
Mailing Address - Phone:319-283-6153
Mailing Address - Fax:319-283-6151
Practice Address - Street 1:129 8TH AVE SE
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-2352
Practice Address - Country:US
Practice Address - Phone:319-283-6153
Practice Address - Fax:319-283-6151
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA112584363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily