=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992209159
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA ANN LENZ BSNRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2018
-----------------------------------------------------
Last Update Date | 03/22/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 7TH AVE
-----------------------------------------------------
City | KEARNEY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68845-3386
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-698-8280
-----------------------------------------------------
Fax | 308-698-8283
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 216 E 52ND ST
-----------------------------------------------------
City | KEARNEY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68847-8506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-627-3854
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 50504
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------