=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235924200
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDI LENTZ FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2025
-----------------------------------------------------
Last Update Date | 04/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1615 N DELAWARE DR LOT 88
-----------------------------------------------------
City | APACHE JUNCTION
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85120-1851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-908-3022
-----------------------------------------------------
Fax | 815-908-3022
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1615 N DELAWARE DR LOT 88
-----------------------------------------------------
City | APACHE JUNCTION
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85120-1851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-908-3022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 321902
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------