Healthcare Provider Details

I. General information

NPI: 1295333110
Provider Name (Legal Business Name): JONATHON LAWRENCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 E BEARDSLEY RD STE 260
PHOENIX AZ
85024-1287
US

IV. Provider business mailing address

2340 E BEARDSLEY RD STE 260
PHOENIX AZ
85024-1287
US

V. Phone/Fax

Practice location:
  • Phone: 602-802-8240
  • Fax:
Mailing address:
  • Phone: 602-802-8240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA-2779
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberDA12772
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: