Healthcare Provider Details

I. General information

NPI: 1811704877
Provider Name (Legal Business Name): SUSAN DIANE LANTZ PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 VETERANS MEMORIAL PKWY
RIVERSIDE RI
02915-5099
US

IV. Provider business mailing address

1 DROWNE PKWY
RUMFORD RI
02916-1607
US

V. Phone/Fax

Practice location:
  • Phone: 401-432-1000
  • Fax:
Mailing address:
  • Phone: 646-717-3155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN04375
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: