Healthcare Provider Details

I. General information

NPI: 1780969154
Provider Name (Legal Business Name): KATIE LYNN LAWRENCE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6740 4TH AVE
BROOKLYN NY
11220-5350
US

IV. Provider business mailing address

100 REMSEN ST APT 1C
BROOKLYN NY
11201-4217
US

V. Phone/Fax

Practice location:
  • Phone: 929-455-2000
  • Fax:
Mailing address:
  • Phone: 410-353-9528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number001623
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberLK-0000161
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number001623
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: