Healthcare Provider Details

I. General information

NPI: 1356836167
Provider Name (Legal Business Name): LAWRENCE KING-RAY CHEN ARNP, AGPCNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E SAMPLE RD STE 105
POMPANO BEACH FL
33064-4443
US

IV. Provider business mailing address

601 E SAMPLE RD STE 105
POMPANO BEACH FL
33064-4443
US

V. Phone/Fax

Practice location:
  • Phone: 954-943-1133
  • Fax:
Mailing address:
  • Phone: 954-943-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP9348909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: