Healthcare Provider Details

I. General information

NPI: 1184392961
Provider Name (Legal Business Name): MICHAEL EDWARD LAWRIE PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2021
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 ALLEN ST STE 403
RUTLAND VT
05701-4570
US

IV. Provider business mailing address

71 ALLEN ST STE 403
RUTLAND VT
05701-4570
US

V. Phone/Fax

Practice location:
  • Phone: 802-772-7992
  • Fax:
Mailing address:
  • Phone: 802-772-7992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number101.0134944
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: