1134425333 NPI number — JENNIFER LENTZ PA-C

Table of content: JENNIFER LENTZ PA-C (NPI 1134425333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134425333 NPI number — JENNIFER LENTZ PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LENTZ
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARSULA
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134425333
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 DUTCH RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15009-9727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-773-8289
Provider Business Mailing Address Fax Number:
724-773-4532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 DUTCH RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15009-9727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-773-8289
Provider Business Practice Location Address Fax Number:
724-773-4532
Provider Enumeration Date:
02/04/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  MA054802 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)