Healthcare Provider Details

I. General information

NPI: 1184617334
Provider Name (Legal Business Name): MARY LAWLOR C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 S BERNARD ST # 200
SPOKANE WA
99204-2509
US

IV. Provider business mailing address

427 S BERNARD ST # 200
SPOKANE WA
99204-2509
US

V. Phone/Fax

Practice location:
  • Phone: 509-456-8150
  • Fax: 509-455-9887
Mailing address:
  • Phone: 509-456-8150
  • Fax: 509-455-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00092406
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30003785
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: