Provider Demographics
NPI:1457524019
Name:LENZ, CHRISTA W (RD)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:W
Last Name:LENZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:L
Other - Last Name:WILLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1022 N SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1531
Mailing Address - Country:US
Mailing Address - Phone:231-690-2317
Mailing Address - Fax:
Practice Address - Street 1:1 N ATKINSON DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1906
Practice Address - Country:US
Practice Address - Phone:231-845-2369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered