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NPI Code Detail

MEDICARE: MS. MARY R LAWRENCE RN CDE

MEDICARE: MS. MARY R LAWRENCE RN CDE
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
1163WD0400XDiabetes Educator Registered Nurse063270MO

General Provider Information

NPI Number : 1962523290
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY R LAWRENCE RN CDE
Provider Business Mailing Address
First Line : 10010 KENNERLY RD
Second Line : ST. ANTHONY MEDICAL CENTER, DIABETES EDUCATION
City : SAINT LOUIS
State : MO
Zip : 63128-2106
Country : US
Telephone Number : 314-525-4506
Fax Number : 314-525-4260
Provider Business Practice Location Address
First Line : 10010 KENNERLY RD
Second Line : ST. ANTHONY MEDICAL CENTER, DIABETES EDUCATION
City : SAINT LOUIS
State : MO
Zip : 63128-2106
Country : US
Telephone Number : 314-525-4506
Fax Number : 314-525-4260
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2007
Last Update Date : 07/09/2007

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