Provider Demographics
NPI:1457476178
Name:LORENZ, BONNIE ARENT (LAC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:ARENT
Last Name:LORENZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 SW WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4405
Mailing Address - Country:US
Mailing Address - Phone:541-758-9334
Mailing Address - Fax:541-758-1334
Practice Address - Street 1:456 SW WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4405
Practice Address - Country:US
Practice Address - Phone:541-758-9334
Practice Address - Fax:541-758-1334
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC000235171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150606Medicaid
OR95567OtherHEALTHNET CA AND OR
ORCIGNAOther62308
OR93029OtherPACIFICSOURCE HEALTH PLAN
OR87726OtherUNITED HEALTHCARE
OR055622000OtherBCBS
OR63665OtherGREAT-WEST HEALTHCARE
ORFIRST HEALTH NETWORKOther87043