Healthcare Provider Details

I. General information

NPI: 1902183767
Provider Name (Legal Business Name): LYNN LANZA MS. RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 E INSIGHT WAY
CHANDLER AZ
85286-1930
US

IV. Provider business mailing address

2701 E INSIGHT WAY
CHANDLER AZ
85286-1930
US

V. Phone/Fax

Practice location:
  • Phone: 480-409-6100
  • Fax: 480-409-6101
Mailing address:
  • Phone: 480-409-6100
  • Fax: 480-409-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1023686
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number21600246
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: