MEDICARE: MRS. DONNA LEE LANZA CNP

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
1	363L00000X	Nurse Practitioner	RN137963	OH

General Provider Information

NPI Number	:	1689652042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA LEE LANZA CNP

Provider Business Mailing Address
First Line	:	11330 VILLA GRANDE DR
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-3261
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12744 STATE RD
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-3910
Country	:	US
Telephone Number	:	440-582-1484
Fax Number	:	440-582-1594

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	03/01/2011

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