Healthcare Provider Details

I. General information

NPI: 1104047851
Provider Name (Legal Business Name): DANIEL DAVID LANTZ JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 PENLAND PKWY SUITE J11
ANCHORAGE AK
99508-1906
US

IV. Provider business mailing address

10135 LEDOUX LN
EAGLE RIVER AK
99577-8366
US

V. Phone/Fax

Practice location:
  • Phone: 907-279-8055
  • Fax:
Mailing address:
  • Phone: 907-694-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number6692
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: