MEDICARE: KRISTA L LAWRENCE FNP-BC

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	363LF0000X	Family Nurse Practitioner	RN237527	MA

General Provider Information

NPI Number	:	1336574169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA L LAWRENCE FNP-BC

Provider Business Mailing Address
First Line	:	21 NAUTICAL WAY
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-8611
Country	:	US
Telephone Number	:	508-224-6295
Fax Number	:	508-224-6295

Provider Business Practice Location Address
First Line	:	207 ROCKLAND ST
Second Line	:
City	:	HANOVER
State	:	MA
Zip	:	02339-2222
Country	:	US
Telephone Number	:	781-826-8381
Fax Number	:

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

Provider Enumeration Date	:	09/11/2013
Last Update Date	:	09/11/2013

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