Healthcare Provider Details

I. General information

NPI: 1053086694
Provider Name (Legal Business Name): OLIVIA LANTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LAKESHORE DRIVE SAMFORD UNIVERSITY, DEPT. OF NURSE ANESTHESIA
BIRMINGHAM AL
35229
US

IV. Provider business mailing address

800 LAKESHORE DRIVE SAMFORD UNIVERSITY, DEPT. OF NURSE ANESTHESIA
BIRMINGHAM AL
35229
US

V. Phone/Fax

Practice location:
  • Phone: 205-726-2401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024187368
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: