Individual
LEO J LANTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3000 32ND AVE S, FARGO, ND 58103-6132
(701) 364-8000
(701) 364-8078
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-3300
(701) 364-8078
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R24550
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029018100
—
ND
05
—
12655
—
ND
01
—
142339
UCARE #
ND
01
—
2000789
MEDICA INNOVIS #
ND
01
—
2000790
MEDICA FARGO #
ND
01
—
3881
NDBS #
ND
01
—
38T21LA
MNBS #
ND
01
—
DA9011015555
PREF 1
ND
01
—
HP38625
HEALTHPARTNERS #
ND
Enumeration date
06/15/2006
Last updated
06/13/2012
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