Provider Demographics
NPI:1417785551
Name:LANTZ, ELLEN ANNE (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:ANNE
Last Name:LANTZ
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MRS
Other - First Name:ELLEN
Other - Middle Name:TREY
Other - Last Name:LANTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LD
Mailing Address - Street 1:59364 210TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMEROY
Mailing Address - State:IA
Mailing Address - Zip Code:50575-8032
Mailing Address - Country:US
Mailing Address - Phone:712-358-0038
Mailing Address - Fax:
Practice Address - Street 1:802 KENYON ROAD
Practice Address - Street 2:TRINITY REGIONAL MEDICAL CENTER NUTRITIONAL SERVICES
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501
Practice Address - Country:US
Practice Address - Phone:712-358-0038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00515133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered