Individual
MS. JENNIFER DALE LENTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
24276 AIRPORT RD, EAGLE BUTTE, SD 57625-8021
(605) 964-7724
Mailing address
3330 GILROY DR, INDIAN LAND, SC 29707-5533
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-00584
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
897813A
—
NC
Enumeration date
10/25/2006
Last updated
06/20/2024
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