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General NPI Number Information
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NPI Number | 1568719094
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Entity Type | Individual
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Provider Name | JENNIFER LENZ NP
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Gender | Female
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 43525 ELIZABETH ST
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-1034
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Country | US
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Telephone | 586-469-5491
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Fax |
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Provider Business Mailing Address
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Address Line | 13448 LOWE DR
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City | WARREN
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State | MI
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Zip | 48088-1326
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Country | US
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Telephone | 586-979-0167
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 4704198538
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License Number State | MI
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