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General NPI Number Information
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NPI Number | 1922117738
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Entity Type | Individual
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Provider Name | MARY ELLEN LAWRENCE M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | NAZ HOSPITALISTS 1003 WILLOW CREEK RD
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City | PRESCOTT
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State | AZ
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Zip | 86305
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Country | US
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Telephone | 928-771-5470
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Fax | 928-771-5471
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Provider Business Mailing Address
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Address Line | 6 LOS GATOS LN
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City | SANTA FE
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State | NM
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Zip | 87507-4258
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Country | US
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Telephone | 505-629-8260
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | MD2003-0768
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 42015
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License Number State | AZ
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