Provider Demographics
NPI:1073990677
Name:LAWRENCE, TAFRICA SHANTA
Entity Type:Individual
Prefix:
First Name:TAFRICA
Middle Name:SHANTA
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9915 HANNON DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-1701
Mailing Address - Country:US
Mailing Address - Phone:832-230-0485
Mailing Address - Fax:713-983-8373
Practice Address - Street 1:9915 HANNON DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-1701
Practice Address - Country:US
Practice Address - Phone:832-230-0485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor