Healthcare Provider Details

I. General information

NPI: 1275565152
Provider Name (Legal Business Name): KATHRYN M LAWRENCE ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 NORTHLINE AVE STE 250
GREENSBORO NC
27408-7619
US

IV. Provider business mailing address

PO BOX 405633
ATLANTA GA
30384-5633
US

V. Phone/Fax

Practice location:
  • Phone: 336-938-0800
  • Fax:
Mailing address:
  • Phone: 888-563-3282
  • Fax: 605-677-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5003625
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: