Individual
DR. KELLI JO LORENTSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2601 E ROOSEVELT ST, MARICOPA MEDICAL CENTER, PEDS ED, PHOENIX, AZ 85008-4973
(602) 344-5404
Mailing address
2601 E ROOSEVELT ST, MARICOPA MEDICAL CENTER, PEDS ED, PHOENIX, AZ 85008-4973
(602) 344-5404
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
21820
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
191320
—
AZ
Enumeration date
09/11/2007
Last updated
09/11/2007
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