Provider Demographics
NPI:1821375437
Name:LENZ, CHARLENE NANNETTE
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:NANNETTE
Last Name:LENZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 GRAND AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-1080
Mailing Address - Country:US
Mailing Address - Phone:419-921-5676
Mailing Address - Fax:
Practice Address - Street 1:19 GRAND AVE APT 14
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-1080
Practice Address - Country:US
Practice Address - Phone:419-921-5976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401309461011376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide