Healthcare Provider Details

I. General information

NPI: 1245235969
Provider Name (Legal Business Name): CHARLOTTE L LANTZ CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 ELIZABETH PIKE
ELIZABETH WV
26143-0609
US

IV. Provider business mailing address

PO BOX 609
ELIZABETH WV
26143-0609
US

V. Phone/Fax

Practice location:
  • Phone: 304-275-3301
  • Fax: 304-275-4798
Mailing address:
  • Phone: 304-275-3301
  • Fax: 304-275-4798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number36761
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: