1457476178 NPI number — BONNIE ARENT LORENZ L.AC.

Table of content: KAITLIN ROSE NEISWENTER OTR/L (NPI 1093590655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457476178 NPI number — BONNIE ARENT LORENZ L.AC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LORENZ
Provider First Name:
BONNIE
Provider Middle Name:
ARENT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.AC.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457476178
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
456 SW WASHINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORVALLIS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97333-4405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-758-9334
Provider Business Mailing Address Fax Number:
541-758-1334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
456 SW WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORVALLIS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97333-4405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-758-9334
Provider Business Practice Location Address Fax Number:
541-758-1334
Provider Enumeration Date:
03/20/2007

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: 171100000X , with the licence number:  AC000235 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 150606 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95567 . This is a "HEALTHNET CA AND OR" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: CIGNA . This is a "62308" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 93029 . This is a "PACIFICSOURCE HEALTH PLAN" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 87726 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 055622000 . This is a "BCBS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 63665 . This is a "GREAT-WEST HEALTHCARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: FIRST HEALTH NETWORK . This is a "87043" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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