Healthcare Provider Details

I. General information

NPI: 1952564213
Provider Name (Legal Business Name): JENNIFER LAWHORN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N OTSEGO AVE
GAYLORD MI
49735-1558
US

IV. Provider business mailing address

271 MCCOY RD W
GAYLORD MI
49735-8253
US

V. Phone/Fax

Practice location:
  • Phone: 989-731-7760
  • Fax: 989-731-7748
Mailing address:
  • Phone: 989-731-7708
  • Fax: 989-731-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101017637
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number5101017637
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: