Healthcare Provider Details

I. General information

NPI: 1336794205
Provider Name (Legal Business Name): GUADALUPE LAWRENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 SAVANNAH RD
LEWES DE
19958-1462
US

IV. Provider business mailing address

3643 SW 20TH AVE APT 203
GAINESVILLE FL
32607-4450
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-3300
  • Fax:
Mailing address:
  • Phone: 305-335-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number9422465
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: