MEDICARE: MRS. NICOLE DANIELLE LAWRENCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1285380030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE DANIELLE LAWRENCE

Provider Business Mailing Address
First Line	:	1249 SPRING PARK WALK
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-0029
Country	:	US
Telephone Number	:	513-680-1327
Fax Number	:

Provider Business Practice Location Address
First Line	:	1249 SPRING PARK WALK
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-0029
Country	:	US
Telephone Number	:	513-680-1327
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2022
Last Update Date	:	03/01/2022

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