Provider Demographics
NPI:1073531109
Name:LAWRENCE, NICOLA C (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLA
Middle Name:C
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2550 THUNDERBIRD CIR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1215
Mailing Address - Country:US
Mailing Address - Phone:480-924-8382
Mailing Address - Fax:480-924-8399
Practice Address - Street 1:2550 THUNDERBIRD CIR
Practice Address - Street 2:SUITE 303
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1215
Practice Address - Country:US
Practice Address - Phone:480-924-8382
Practice Address - Fax:480-924-8399
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-05-19
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Provider Licenses
StateLicense IDTaxonomies
AZ3367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant