Provider Demographics
NPI:1265843411
Name:LAWRENCE, ELNORA (RN,BSN,CWS)
Entity Type:Individual
Prefix:
First Name:ELNORA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:RN,BSN,CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1153
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-0039
Mailing Address - Country:US
Mailing Address - Phone:228-369-4016
Mailing Address - Fax:
Practice Address - Street 1:1617 LARK DR
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-3131
Practice Address - Country:US
Practice Address - Phone:228-369-4016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR853946163W00000X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WW0000XNursing Service ProvidersRegistered NurseWound Care