Healthcare Provider Details

I. General information

NPI: 1164208815
Provider Name (Legal Business Name): LINDSEY CAMILLE NANZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/07/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 S JEFFERSON ST
ROANOKE VA
24016-4705
US

IV. Provider business mailing address

5677 GRANDIN ROAD EXT
ROANOKE VA
24018-7863
US

V. Phone/Fax

Practice location:
  • Phone: 540-985-9885
  • Fax: 540-857-9130
Mailing address:
  • Phone: 540-492-1249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number0140000050
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: