Healthcare Provider Details

I. General information

NPI: 1295451300
Provider Name (Legal Business Name): JOSE MARIA OLYMPIA LORENZANA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W MARINE VIEW DR
EVERETT WA
98207-0001
US

IV. Provider business mailing address

4744 CHARTER LN APT 203
MUKILTEO WA
98275-6045
US

V. Phone/Fax

Practice location:
  • Phone: 425-304-4068
  • Fax:
Mailing address:
  • Phone: 480-326-4896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number735539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: