Provider Demographics
NPI:1194449215
Name:LORENTZ, MASHALA
Entity type:Individual
Prefix:MRS
First Name:MASHALA
Middle Name:
Last Name:LORENTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 COUNTY ROAD 16
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:44851-9518
Mailing Address - Country:US
Mailing Address - Phone:567-217-1954
Mailing Address - Fax:
Practice Address - Street 1:525 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-1606
Practice Address - Country:US
Practice Address - Phone:567-217-1954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0063701Medicaid