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General NPI Number Information
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NPI Number | 1881300150
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Entity Type | Individual
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Provider Name | AYANNA LAWRENCE HAIR LOSS SPECIALIST
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Gender | Female
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 8200 PERRY HALL BLVD STE 138
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City | BALTIMORE
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State | MD
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Zip | 21236-4901
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Country | US
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Telephone | 410-258-5548
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Fax |
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Provider Business Mailing Address
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Address Line | 1045 N BROADWAY
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City | BALTIMORE
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State | MD
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Zip | 21205-1121
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Country | US
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Telephone | 410-419-0906
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | 217777
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License Number State | MD
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