Provider Demographics
NPI:1104047851
Name:LANTZ, DANIEL DAVID JR (RN)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:DAVID
Last Name:LANTZ
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10135 LEDOUX LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8366
Mailing Address - Country:US
Mailing Address - Phone:907-694-6018
Mailing Address - Fax:
Practice Address - Street 1:3101 PENLAND PKWY
Practice Address - Street 2:SUITE J11
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1906
Practice Address - Country:US
Practice Address - Phone:907-279-8055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6692163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy