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General NPI Number Information
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NPI Number | 1700757184
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Entity Type | Individual
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Provider Name | BREANNA LAWRENCE CSFA
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Gender | Female
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 3050 HALSTEAD BLVD
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City | ELIZABETH CITY
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State | NC
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Zip | 27909
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Country | US
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Telephone | 252-690-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 1252 4 FORKS RD
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-7252
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Country | US
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Telephone | 757-525-0158
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 187178
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License Number State | NC
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