Provider Demographics
NPI:1588646772
Name:LENZMEIER, BRIAN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:LENZMEIER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 OLD JACKSBORO HWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2134
Mailing Address - Country:US
Mailing Address - Phone:940-500-4048
Mailing Address - Fax:833-320-1559
Practice Address - Street 1:4000 OLD JACKSBORO HWY
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2134
Practice Address - Country:US
Practice Address - Phone:940-500-4048
Practice Address - Fax:833-320-1559
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003021292367500000X
WI4021-33363L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1588646772Medicaid
MO1588646772Medicaid
MOS55F465Medicare PIN
MO825843155Medicare PIN
000341960Medicare PIN