Provider Demographics
NPI:1427300680
Name:HARTZ, LORI L (APNP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:HARTZ
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 N PORT WASHINGTON RD
Mailing Address - Street 2:STE 325
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1004
Mailing Address - Country:US
Mailing Address - Phone:414-269-8282
Mailing Address - Fax:414-269-8280
Practice Address - Street 1:4655N PORT WASHINGTON RD 325
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1000
Practice Address - Country:US
Practice Address - Phone:414-269-8282
Practice Address - Fax:414-269-8280
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5025-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI521829Medicare Oscar/Certification
WI0000002690OtherMEDICARE PTAN