MEDICARE: CHARLOTTE LORRAINE LANZA

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	164W00000X	Licensed Practical Nurse	276824-1	NY

General Provider Information

NPI Number	:	1821235532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE LORRAINE LANZA

Provider Business Mailing Address
First Line	:	3178 WHARTON DR
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-2525
Country	:	US
Telephone Number	:	914-572-4993
Fax Number	:	914-962-0262

Provider Business Practice Location Address
First Line	:	3178 WHARTON DR
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-2525
Country	:	US
Telephone Number	:	914-572-4993
Fax Number	:	914-962-0262

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

Provider Enumeration Date	:	01/16/2009
Last Update Date	:	01/16/2009

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