Provider Demographics
NPI:1891411815
Name:LAVRENZ, ARIANA EVE
Entity Type:Individual
Prefix:
First Name:ARIANA
Middle Name:EVE
Last Name:LAVRENZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVE
Other - Middle Name:
Other - Last Name:LAVRENZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1315 CARR LAKE RD SW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-8253
Mailing Address - Country:US
Mailing Address - Phone:215-556-6037
Mailing Address - Fax:
Practice Address - Street 1:616 AMERICA AVE NW STE 130
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3848
Practice Address - Country:US
Practice Address - Phone:218-333-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker