Provider Demographics
NPI:1295769693
Name:LORENZ, ROBERT M (RN,ANP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:LORENZ
Suffix:
Gender:M
Credentials:RN,ANP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10012 KENNERLY RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-880-6676
Mailing Address - Fax:314-842-4372
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:SUITE 403
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-880-6676
Practice Address - Fax:314-842-4372
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO102265363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO102265OtherRN LICENSE