Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 5377136062 | KS |
N | 363LF0000X | Nurse Practitioner - Family Medicine | R190962 | MD |
NPI | 1003161548 |
---|---|
Provider Name | Allyson Dibert Lenz |
First Address | Overland Park, KS 66223-2162 |
Second Address | Overland Park, KS 66211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2012 |
Last Update Date | 27/08/2020 |