Provider Demographics
NPI:1487161444
Name:LORENZ, MANDY MARIE (RN)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:MARIE
Last Name:LORENZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:MARIE
Other - Last Name:MOREHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1716 ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-5152
Mailing Address - Country:US
Mailing Address - Phone:920-208-4809
Mailing Address - Fax:
Practice Address - Street 1:1716 ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-5152
Practice Address - Country:US
Practice Address - Phone:920-208-4809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI235062163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse