=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184160616
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANICE E LAWRENZ CST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2017
-----------------------------------------------------
Last Update Date | 01/08/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7700 CLOCKTOWER DR H-211B
-----------------------------------------------------
City | KIRTLAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44094-5198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-525-7016
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9891 TANBARK TRL
-----------------------------------------------------
City | MENTOR
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44060-7241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-478-6806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZS0410X
-----------------------------------------------------
Taxonomy Name | Surgical Technologist
-----------------------------------------------------
License Number | 127246
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------