Provider Demographics
NPI:1265676050
Name:LAWRENCE, CHERYL W (LD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:W
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 E I 30
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-4120
Mailing Address - Country:US
Mailing Address - Phone:214-607-4000
Mailing Address - Fax:800-669-2161
Practice Address - Street 1:880 E I 30
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-4120
Practice Address - Country:US
Practice Address - Phone:214-607-4000
Practice Address - Fax:800-669-2161
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX442275133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202471303Medicaid