MEDICARE: MS. PATRICE ANN LAWRENCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	230028100	FL

General Provider Information

NPI Number	:	1144298852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICE ANN LAWRENCE

Provider Business Mailing Address
First Line	:	4221 NW 11TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33127-2708
Country	:	US
Telephone Number	:	305-635-5742
Fax Number	:

Provider Business Practice Location Address
First Line	:	4221 NW 11TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33127-2708
Country	:	US
Telephone Number	:	305-635-5742
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	04/24/2008

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