Healthcare Provider Details

I. General information

NPI: 1578026399
Provider Name (Legal Business Name): HOLLY LORENZEN MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 19TH ST SE # 1A
RIO RANCHO NM
87124-4857
US

IV. Provider business mailing address

1740 GRANDE BLVD SE STE E10E16
RIO RANCHO NM
87124-1799
US

V. Phone/Fax

Practice location:
  • Phone: 505-452-4200
  • Fax:
Mailing address:
  • Phone: 505-504-1147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number64776
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number64776
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNP95011277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: