Healthcare Provider Details

I. General information

NPI: 1265843411
Provider Name (Legal Business Name): ELNORA LAWRENCE RN,BSN,CWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 LARK DR
GAUTIER MS
39553-3131
US

IV. Provider business mailing address

PO BOX 1153
GAUTIER MS
39553-0039
US

V. Phone/Fax

Practice location:
  • Phone: 228-369-4016
  • Fax:
Mailing address:
  • Phone: 228-369-4016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR853946
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberR853946
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: