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General NPI Number Information
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NPI Number | 1811704877
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Entity Type | Individual
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Provider Name | SUSAN DIANE LANTZ PMHNP
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Gender | Female
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 1011 VETERANS MEMORIAL PKWY
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City | RIVERSIDE
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State | RI
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Zip | 02915-5099
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Country | US
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Telephone | 401-432-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1 DROWNE PKWY
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City | RUMFORD
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State | RI
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Zip | 02916-1607
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Country | US
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Telephone | 646-717-3155
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN04375
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License Number State | RI
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