Provider Demographics
NPI:1700564945
Name:LANZ, TREVOR (RN)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:LANZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13261 179TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-4519
Mailing Address - Country:US
Mailing Address - Phone:702-580-0522
Mailing Address - Fax:
Practice Address - Street 1:419 S 2ND ST STE 2
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2234
Practice Address - Country:US
Practice Address - Phone:425-203-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60204613163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical