MEDICARE: MS. CANDACE 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	171M00000X	Case Manager/Care Coordinator	175319661	MI

General Provider Information

NPI Number	:	1700732377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CANDACE LAWRENCE

Provider Business Mailing Address
First Line	:	129 JEFFERSON AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-4324
Country	:	US
Telephone Number	:	616-315-4402
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 JEFFERSON AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-4324
Country	:	US
Telephone Number	:	616-315-4402
Fax Number	:

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

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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Directions to “ MS. CANDACE LAWRENCE ” Practice Location

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