Healthcare Provider Details

I. General information

NPI: 1881300150
Provider Name (Legal Business Name): AYANNA LAWRENCE HAIR LOSS SPECIALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 PERRY HALL BLVD STE 138
BALTIMORE MD
21236-4901
US

IV. Provider business mailing address

1045 N BROADWAY
BALTIMORE MD
21205-1121
US

V. Phone/Fax

Practice location:
  • Phone: 410-258-5548
  • Fax:
Mailing address:
  • Phone: 410-419-0906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number217777
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: