Healthcare Provider Details

I. General information

NPI: 1255426920
Provider Name (Legal Business Name): REBECCA K LAWRENCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 CRANBERRY BLVD
WESTON WI
54476-5216
US

IV. Provider business mailing address

3301 CRANBERRY BLVD
WESTON WI
54476-5216
US

V. Phone/Fax

Practice location:
  • Phone: 715-393-3900
  • Fax:
Mailing address:
  • Phone: 715-393-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number26229
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: