Healthcare Provider Details

I. General information

NPI: 1659503506
Provider Name (Legal Business Name): DIANE HELEN LAWRENCE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 DELLWOOD ST S
CAMBRIDGE MN
55008-1920
US

IV. Provider business mailing address

1603 W OLD SHAKOPEE RD
BLOOMINGTON MN
55431-3065
US

V. Phone/Fax

Practice location:
  • Phone: 763-689-8700
  • Fax: 763-688-7941
Mailing address:
  • Phone: 952-767-3294
  • Fax: 952-767-0018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR 153275-5
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2009006246
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: