Provider Demographics
NPI:1275052334
Name:LAWRENCE, HEATHER D (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 ENTRY RD
Mailing Address - Street 2:
Mailing Address - City:AULTMAN
Mailing Address - State:PA
Mailing Address - Zip Code:15713-9601
Mailing Address - Country:US
Mailing Address - Phone:724-464-4182
Mailing Address - Fax:
Practice Address - Street 1:440 ENTRY RD
Practice Address - Street 2:
Practice Address - City:AULTMAN
Practice Address - State:PA
Practice Address - Zip Code:15713-9601
Practice Address - Country:US
Practice Address - Phone:724-464-4182
Practice Address - Fax:724-464-4182
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN569343163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN569343OtherRN