Provider Demographics
NPI:1235697228
Name:LAWRENCE-BROWN, KEYARAH DENISE I
Entity Type:Individual
Prefix:
First Name:KEYARAH
Middle Name:DENISE
Last Name:LAWRENCE-BROWN
Suffix:I
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 1:16854 EDMORE DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-1516
Mailing Address - Country:US
Mailing Address - Phone:313-316-8256
Mailing Address - Fax:
Practice Address - Street 1:16854 EDMORE DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1516
Practice Address - Country:US
Practice Address - Phone:313-316-8256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L652465138552156FC0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIL652465139552OtherNONE