Healthcare Provider Details

I. General information

NPI: 1922117738
Provider Name (Legal Business Name): MARY ELLEN LAWRENCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAZ HOSPITALISTS 1003 WILLOW CREEK RD
PRESCOTT AZ
86305
US

IV. Provider business mailing address

6 LOS GATOS LN
SANTA FE NM
87507-4258
US

V. Phone/Fax

Practice location:
  • Phone: 928-771-5470
  • Fax: 928-771-5471
Mailing address:
  • Phone: 505-629-8260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD2003-0768
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number42015
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: