Basic Information
| Provider Information | |||||||||
| NPI: | 1700422490 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LORENTZ | ||||||||
| FirstName: | LORRAINE | ||||||||
| MiddleName: | KATHLEEN | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 NW SOUTH OUTER RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | BLUE SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640153069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882563814 | ||||||||
| FaxNumber: | 8882569054 | ||||||||
| Practice Location | |||||||||
| Address1: | 3011 N MICHIGAN ST | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667622546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202319873 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2019 | ||||||||
| LastUpdateDate: | 06/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | CP001684 | SD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 79350 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.