Provider Demographics
NPI:1831891167
Name:LENZ, AUDREY
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:LENZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3087 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-7211
Mailing Address - Country:US
Mailing Address - Phone:701-690-5998
Mailing Address - Fax:
Practice Address - Street 1:766 ELKS DR
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-2915
Practice Address - Country:US
Practice Address - Phone:701-483-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDL12179164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse