Provider Demographics
NPI:1902183767
Name:LANZA, LYNN (MS RD, CDE)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:LANZA
Suffix:
Gender:F
Credentials:MS RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 E INSIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1930
Mailing Address - Country:US
Mailing Address - Phone:480-409-6100
Mailing Address - Fax:480-409-6101
Practice Address - Street 1:2701 E INSIGHT WAY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-1930
Practice Address - Country:US
Practice Address - Phone:480-409-6100
Practice Address - Fax:480-409-6101
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21600246174H00000X
AZ1023686133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth Educator