Healthcare Provider Details

I. General information

NPI: 1295050664
Provider Name (Legal Business Name): JENILEE V. LAWRENCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 08/08/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 N MEDICAL PARK DR
FISHERSVILLE VA
22939-2344
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939-0388
US

V. Phone/Fax

Practice location:
  • Phone: 540-213-2630
  • Fax: 540-213-2631
Mailing address:
  • Phone: 540-213-2630
  • Fax: 540-213-2631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101254134
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101254134
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: