Provider Demographics
NPI:1619143757
Name:LORENZ, KATHLEEN ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANN
Last Name:LORENZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:KIBLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:88 EAST 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-5059
Mailing Address - Country:US
Mailing Address - Phone:920-923-5623
Mailing Address - Fax:
Practice Address - Street 1:88 EAST 11TH STREET
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-5059
Practice Address - Country:US
Practice Address - Phone:920-923-5623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4561031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39803800Medicaid