Provider Demographics
NPI:1154932036
Name:LORENZEN, BRIAN (FNP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:LORENZEN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BARKER ST APT 513
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-1635
Mailing Address - Country:US
Mailing Address - Phone:914-275-6772
Mailing Address - Fax:
Practice Address - Street 1:25 BARKER ST APT 513
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-1635
Practice Address - Country:US
Practice Address - Phone:914-275-6772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345684363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care