Healthcare Provider Details

I. General information

NPI: 1386662476
Provider Name (Legal Business Name): VIRGINIA MARIA LAWRENCE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 OLD SAWMILL LN
ARUNDEL ME
04046-8164
US

IV. Provider business mailing address

9 OLD SAWMILL LN
ARUNDEL ME
04046-8164
US

V. Phone/Fax

Practice location:
  • Phone: 207-985-8998
  • Fax: 207-985-1281
Mailing address:
  • Phone: 207-985-8998
  • Fax: 207-985-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP81746
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN25906
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: