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General NPI Number Information
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NPI Number | 1396358255
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Entity Type | Individual
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Provider Name | VYVIAN CHARLENE LAWRENCE DVM
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Gender | Female
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 5939 W LINCOLN HWY
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City | CROWN POINT
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State | IN
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Zip | 46307-9604
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Country | US
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Telephone | 219-515-6904
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Fax |
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Provider Business Mailing Address
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Address Line | 707 81ST ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-4333
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Country | US
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Telephone | 630-664-8696
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 090004455
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License Number State | IL
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