Healthcare Provider Details

I. General information

NPI: 1598918336
Provider Name (Legal Business Name): MATTHEW G LAWRENCE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LOCUST ST 4ND FLOOR, ICU
NORTHAMPTON MA
01060-2052
US

IV. Provider business mailing address

30 LOCUST ST 4ND FLOOR, ICU
NORTHAMPTON MA
01060-2052
US

V. Phone/Fax

Practice location:
  • Phone: 413-582-2000
  • Fax:
Mailing address:
  • Phone: 413-582-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number272480
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: