Provider Demographics
NPI:1629583737
Name:LENZ, REBECCA ANN (RN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:LENZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 PILGRIM TRL
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2425
Mailing Address - Country:US
Mailing Address - Phone:608-387-3313
Mailing Address - Fax:608-387-3313
Practice Address - Street 1:333 E CAMPUS MALL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1365
Practice Address - Country:US
Practice Address - Phone:608-265-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171150-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse