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General NPI Number Information
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NPI Number | 1992493340
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Entity Type | Individual
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Provider Name | MICHAEL LAWRENCE
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Gender | Male
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Dates
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Enumeration Date | 04/25/2023
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 4545 N. 67TH AVE. UNIT 1176
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City | PHOENIX
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State | AZ
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Zip | 85033
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Country | US
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Telephone | 928-504-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 4545 N 67TH AVE UNIT 1176
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City | PHOENIX
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State | AZ
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Zip | 85033-1677
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 227837
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License Number State | AZ
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