Provider Demographics
NPI:1144295635
Name:LANTZ, LESLEY G (NP)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:G
Last Name:LANTZ
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1919 STATE ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4929
Mailing Address - Country:US
Mailing Address - Phone:812-945-5233
Mailing Address - Fax:812-945-2804
Practice Address - Street 1:1919 STATE ST
Practice Address - Street 2:SUITE 340
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4929
Practice Address - Country:US
Practice Address - Phone:812-945-5233
Practice Address - Fax:812-945-2804
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2020-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71002081A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN242100HMedicare PIN
INP97340Medicare UPIN