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General NPI Number Information
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NPI Number | 1295026631
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Entity Type | Individual
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Provider Name | AMANDA N LAWRENCE PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/19/2011
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 16759 MAIN ST STE. 201
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City | WILDWOOD
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State | MO
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Zip | 63040-1232
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Country | US
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Telephone | 636-821-1661
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Fax | 636-821-1665
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Provider Business Mailing Address
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Address Line | 16759 MAIN ST STE. 201
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City | WILDWOOD
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State | MO
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Zip | 63040-1232
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Country | US
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Telephone | 636-821-1661
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Fax | 636-821-1665
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2011005771
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License Number State | MO
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