MEDICARE: ELLEN V LORENZ CFNP

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	207Q00000X	Family Medicine Physician	RN026464	AZ

General Provider Information

NPI Number	:	1760444509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN V LORENZ CFNP

Provider Business Mailing Address
First Line	:	3221 N WINDSONG DR
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-1222
Country	:	US
Telephone Number	:	928-910-7010
Fax Number	:	928-910-7011

Provider Business Practice Location Address
First Line	:	3221 N WINDSONG DR
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-1222
Country	:	US
Telephone Number	:	928-910-7010
Fax Number	:	928-910-7011

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	04/23/2020

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