Provider Demographics
NPI:1851364798
Name:LENTZ, DEBRA L (RD MS LD CN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:LENTZ
Suffix:
Gender:F
Credentials:RD MS LD CN
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:181 LEES VALLEY ROAD
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-0278
Mailing Address - Country:US
Mailing Address - Phone:502-955-7837
Mailing Address - Fax:502-543-2998
Practice Address - Street 1:181 LEES VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-0278
Practice Address - Country:US
Practice Address - Phone:502-955-7837
Practice Address - Fax:502-543-2998
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0209133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0223505OtherMEDICARE GROUP
Q07704Medicare UPIN
2235Medicare PIN