Healthcare Provider Details

I. General information

NPI: 1144295635
Provider Name (Legal Business Name): LESLEY G LANTZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 STATE ST SUITE 340
NEW ALBANY IN
47150-4929
US

IV. Provider business mailing address

1919 STATE ST SUITE 340
NEW ALBANY IN
47150-4929
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-5233
  • Fax: 812-945-2804
Mailing address:
  • Phone: 812-945-5233
  • Fax: 812-945-2804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71002081A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: