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NPI Code Detail

MEDICARE: JACQUELINE SUZETTE MARAGH-LAWRENCE APRN

MEDICARE: JACQUELINE SUZETTE MARAGH-LAWRENCE APRN
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
1363L00000XNurse Practitioner2019046943MO

General Provider Information

NPI Number : 1801411301
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE SUZETTE MARAGH-LAWRENCE APRN
Provider Business Mailing Address
First Line : 600 E 5TH ST
Second Line :
City : FULTON
State : MO
Zip : 65251-1793
Country : US
Telephone Number : 573-592-2030
Fax Number :
Provider Business Practice Location Address
First Line : 600 E 5TH ST
Second Line :
City : FULTON
State : MO
Zip : 65251-1793
Country : US
Telephone Number : 573-592-2030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2020
Last Update Date : 06/10/2020

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