Healthcare Provider Details

I. General information

NPI: 1497467948
Provider Name (Legal Business Name): ALEXANDRIA LAWRENCE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 BLUFF RIDGE DR
COLUMBUS OH
43235-1725
US

IV. Provider business mailing address

935 BLUFF RIDGE DR
COLUMBUS OH
43235-1725
US

V. Phone/Fax

Practice location:
  • Phone: 614-483-2206
  • Fax:
Mailing address:
  • Phone: 614-483-2206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: