Provider Demographics
NPI:1578937157
Name:LORENZ, KIRSTEN DAUTERIVE (APRN)
Entity Type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:DAUTERIVE
Last Name:LORENZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:
Other - Last Name:DAUTERIVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BUR
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:890 W FARIS RD STE 580
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605
Practice Address - Country:US
Practice Address - Phone:864-455-7874
Practice Address - Fax:864-455-8933
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22644363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01132720Medicaid
LA2410725Medicaid
SCNP5989Medicaid