Provider Demographics
NPI:1366871170
Name:LORENZEN, NADIA
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:LORENZEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 OBSERVATORY LN
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-9429
Mailing Address - Country:US
Mailing Address - Phone:517-349-2930
Mailing Address - Fax:517-347-9165
Practice Address - Street 1:3545 OBSERVATORY LN
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-9429
Practice Address - Country:US
Practice Address - Phone:517-349-2930
Practice Address - Fax:517-347-9165
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist