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NPI Code Detail

MEDICARE: KELLY DIANE LENTZ RD

MEDICARE: KELLY DIANE LENTZ RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianMI

General Provider Information

NPI Number : 1447478623
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY DIANE LENTZ RD
Provider Business Mailing Address
First Line : 4675 HILL ST
Second Line :
City : CASS CITY
State : MI
Zip : 48726-1008
Country : US
Telephone Number : 989-872-2121
Fax Number : 989-872-5376
Provider Business Practice Location Address
First Line : 4675 HILL ST
Second Line :
City : CASS CITY
State : MI
Zip : 48726-1008
Country : US
Telephone Number : 989-872-2121
Fax Number : 989-872-5376
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2007
Last Update Date : 07/08/2007

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Directions to “ KELLY DIANE LENTZ RD” Practice Location

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