Provider Demographics
NPI:1689652042
Name:LANZA, DONNA LEE (CNP)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LEE
Last Name:LANZA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:LEE
Other - Last Name:VALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNP
Mailing Address - Street 1:11330 VILLA GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-3261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12744 STATE RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-3910
Practice Address - Country:US
Practice Address - Phone:440-582-1484
Practice Address - Fax:440-582-1594
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN137963363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner