Healthcare Provider Details

I. General information

NPI: 1760835946
Provider Name (Legal Business Name): LAURA LAWRENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 STODDARD RD
RICHMOND MI
48062-2505
US

IV. Provider business mailing address

30341 PROGRESS ST
ROSEVILLE MI
48066-4643
US

V. Phone/Fax

Practice location:
  • Phone: 810-395-3530
  • Fax:
Mailing address:
  • Phone: 586-489-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: