Healthcare Provider Details

I. General information

NPI: 1427300680
Provider Name (Legal Business Name): LORI L. HARTZ APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4655N PORT WASHINGTON RD 325
GLENDALE WI
53212-1000
US

IV. Provider business mailing address

4655 N PORT WASHINGTON RD STE 325
GLENDALE WI
53212-1004
US

V. Phone/Fax

Practice location:
  • Phone: 414-269-8282
  • Fax: 414-269-8280
Mailing address:
  • Phone: 414-269-8282
  • Fax: 414-269-8280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5025-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: