Healthcare Provider Details

I. General information

NPI: 1194851451
Provider Name (Legal Business Name): MARILYN LEWIS LANZA DNSC, ARNP, CS, FAAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 E NASHUA RD
WINDHAM NH
03087-1139
US

IV. Provider business mailing address

44 E NASHUA RD
WINDHAM NH
03087-1139
US

V. Phone/Fax

Practice location:
  • Phone: 603-432-8680
  • Fax: 781-687-3337
Mailing address:
  • Phone: 603-432-8680
  • Fax: 781-687-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number014673-23-08
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: