MEDICARE: SUNNY JEAN LAWRENCE RN

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	163W00000X	Registered Nurse	2015016745	MO
2	363LF0000X	Family Nurse Practitioner	2021022493	MO

General Provider Information

NPI Number	:	1437768165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNNY JEAN LAWRENCE RN

Provider Business Mailing Address
First Line	:	379 WEST DD HIGHWAY
Second Line	:
City	:	LAMAR
State	:	MO
Zip	:	64759-6475
Country	:	US
Telephone Number	:	417-850-5656
Fax Number	:

Provider Business Practice Location Address
First Line	:	379 WEST DD HIGHWAY
Second Line	:
City	:	LAMAR
State	:	MO
Zip	:	64759-6475
Country	:	US
Telephone Number	:	417-850-5656
Fax Number	:

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

Provider Enumeration Date	:	07/28/2020
Last Update Date	:	02/22/2022

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