Provider Demographics
NPI:1619967569
Name:LORENZ, JAN (PMHNP)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:LORENZ
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 WOODS RUN
Mailing Address - Street 2:
Mailing Address - City:ROLLINSFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03869
Mailing Address - Country:US
Mailing Address - Phone:562-296-2959
Mailing Address - Fax:903-213-9185
Practice Address - Street 1:108 WOODS RUN
Practice Address - Street 2:
Practice Address - City:ROLLINSFORD
Practice Address - State:NH
Practice Address - Zip Code:03869-0386
Practice Address - Country:US
Practice Address - Phone:903-780-2926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP171177163WP0808X
TX2005000649363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116795906Medicaid
TX8D9399Medicare ID - Type Unspecified
TX116795906Medicaid