Provider Demographics
NPI:1205571155
Name:LENTZ, DINA MICHELLE (PMHNP)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:MICHELLE
Last Name:LENTZ
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 5TH ST
Mailing Address - Street 2:
Mailing Address - City:COLONA
Mailing Address - State:IL
Mailing Address - Zip Code:61241-9795
Mailing Address - Country:US
Mailing Address - Phone:309-373-4884
Mailing Address - Fax:
Practice Address - Street 1:909 5TH ST
Practice Address - Street 2:
Practice Address - City:COLONA
Practice Address - State:IL
Practice Address - Zip Code:61241-9795
Practice Address - Country:US
Practice Address - Phone:309-373-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG168732363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty