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General NPI Number Information
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NPI Number | 1548616949
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Entity Type | Organization
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Legal Business Name | LAHTZE ENTERPRISES LLC
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 7515 S STATE ST
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City | LOWVILLE
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State | NY
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Zip | 13367-1569
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Country | US
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Telephone | 315-376-0376
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Fax | 315-376-0378
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Provider Business Mailing Address
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Address Line | 7515 S STATE ST
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City | LOWVILLE
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State | NY
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Zip | 13367-1569
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Country | US
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Telephone | 315-376-0376
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Fax | 315-376-0378
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | APRIL E DILES
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Credential | PMHNP BC
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Telephone | 315-376-0376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 401513
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License Number State | NY
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