Healthcare Provider Details

I. General information

NPI: 1760476063
Provider Name (Legal Business Name): WOMENS CLINIC ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 S 4TH ST STE 150
LEAVENWORTH KS
66048-5071
US

IV. Provider business mailing address

3550 S 4TH ST STE 150
LEAVENWORTH KS
66048-5071
US

V. Phone/Fax

Practice location:
  • Phone: 913-788-9797
  • Fax: 913-788-5263
Mailing address:
  • Phone: 913-788-9797
  • Fax: 913-788-5263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA A LORENZETTI
Title or Position: PRESIDENT
Credential: MD
Phone: 913-788-9797