Provider Demographics
NPI:1033759378
Name:LAWRENCE, PAMELA SUE (LVN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 N CANAL ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75657-1514
Mailing Address - Country:US
Mailing Address - Phone:903-471-2040
Mailing Address - Fax:
Practice Address - Street 1:708 N CANAL ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:TX
Practice Address - Zip Code:75657-1514
Practice Address - Country:US
Practice Address - Phone:903-471-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116345164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse