Individual
KATHLEEN SUZANNE LORENZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LM
Contact information
Practice address
207 W WASHINGTON ST, BOISE, ID 83702-5989
(208) 343-2079
(208) 343-6828
Mailing address
207 W WASHINGTON ST, BOISE, ID 83702-5989
(208) 343-2079
(208) 343-6828
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
MID-40
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MID-40
BUREAU OF CCCUPATIONAL LICENSES
ID
Enumeration date
11/16/2011
Last updated
11/16/2011
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