Healthcare Provider Details

I. General information

NPI: 1396576922
Provider Name (Legal Business Name): KAITLYN MARIE LORENZEN MA, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N CLARKSON ST
FREMONT NE
68025-4254
US

IV. Provider business mailing address

4727 N 134TH AVE
OMAHA NE
68164-6152
US

V. Phone/Fax

Practice location:
  • Phone: 800-642-8382
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: