Basic Information
| Provider Information | |||||||||
| NPI: | 1629419700 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LORENTZ | ||||||||
| FirstName: | ROSE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | A-G NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12318 120TH ST | ||||||||
| Address2: | |||||||||
| City: | WADENA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564822258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186313194 | ||||||||
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| Practice Location | |||||||||
| Address1: | 415 JEFFERSON ST N | ||||||||
| Address2: | |||||||||
| City: | WADENA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564821264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186313510 | ||||||||
| FaxNumber: | 2186317507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2013 | ||||||||
| LastUpdateDate: | 07/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SA2200X | R116137-5 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health | 364SG0600X | R116137-5 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Gerontology |
No ID Information.