Healthcare Provider Details

I. General information

NPI: 1245316116
Provider Name (Legal Business Name): PAMELA J. LORENZ P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 STATE AVE NE
WARROAD MN
56763-2702
US

IV. Provider business mailing address

10 W MARKET ST STE 2900
INDIANAPOLIS IN
46204-2964
US

V. Phone/Fax

Practice location:
  • Phone: 218-386-4234
  • Fax:
Mailing address:
  • Phone: 866-434-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9058
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAC0056
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: