Provider Demographics
NPI:1659346187
Name:LORENTZ, SUZY GIBSON (NP)
Entity Type:Individual
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First Name:SUZY
Middle Name:GIBSON
Last Name:LORENTZ
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Gender:F
Credentials:NP
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Mailing Address - Street 1:2000 FRONTIS PLAZA BLVD STE 200
Mailing Address - Street 2:(ATTN) FORSYTH MEDICAL GROUP
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5616
Mailing Address - Country:US
Mailing Address - Phone:336-277-2435
Mailing Address - Fax:336-277-9275
Practice Address - Street 1:1351 WESTGATE CENTER DR
Practice Address - Street 2:DBA FORSYTH PEDIATRIC ASSOCIATES - WESTGATE
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2934
Practice Address - Country:US
Practice Address - Phone:336-718-7777
Practice Address - Fax:336-718-7757
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NC72176363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner