Healthcare Provider Details

I. General information

NPI: 1457139982
Provider Name (Legal Business Name): JADEN ANN LENTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 NE 109TH CT
VANCOUVER WA
98662-6177
US

IV. Provider business mailing address

32606 NE PARCEL AVE
YACOLT WA
98675-3803
US

V. Phone/Fax

Practice location:
  • Phone: 360-217-4205
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: