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Individual

MR. MICHAEL P LORENTZEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
190 E BANNOCK ST FL 9, BOISE, ID 83712-6241
(208) 381-2222
Mailing address
2312 N 16TH ST, BOISE, ID 83702-1227
(208) 490-0616

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
56892
ID

Other

Enumeration date
09/11/2017
Last updated
09/30/2017
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