Healthcare Provider Details

I. General information

NPI: 1619967569
Provider Name (Legal Business Name): JAN LORENZ PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WOODS RUN
ROLLINSFORD NH
03869-0386
US

IV. Provider business mailing address

108 WOODS RUN
ROLLINSFORD NH
03869
US

V. Phone/Fax

Practice location:
  • Phone: 903-780-2926
  • Fax:
Mailing address:
  • Phone: 562-296-2959
  • Fax: 903-213-9185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2005000649
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberCNP171177
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: