Provider Demographics
NPI:1699085621
Name:LENZ, EMILY J (NP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:LENZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:116 S MICHIGAN AVE
Mailing Address - Street 2:13TH FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601
Mailing Address - Country:US
Mailing Address - Phone:312-499-4288
Mailing Address - Fax:312-499-4290
Practice Address - Street 1:116 S MICHIGAN AVE
Practice Address - Street 2:13TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601
Practice Address - Country:US
Practice Address - Phone:312-499-4288
Practice Address - Fax:312-499-4290
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209008378363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6447860011Medicare NSC
ILIL3270515Medicare PIN