Provider Demographics
NPI:1821688375
Name:LENZ, NOAH J
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:J
Last Name:LENZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 STATE ST APT B
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-3265
Mailing Address - Country:US
Mailing Address - Phone:419-680-3866
Mailing Address - Fax:
Practice Address - Street 1:480 NORA DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1469
Practice Address - Country:US
Practice Address - Phone:419-680-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant