Provider Demographics
NPI:1306856679
Name:LAWRENCE, LISA M (CNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5147 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-3911
Mailing Address - Country:US
Mailing Address - Phone:330-644-3747
Mailing Address - Fax:330-644-9815
Practice Address - Street 1:5147 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-3911
Practice Address - Country:US
Practice Address - Phone:330-644-3747
Practice Address - Fax:330-644-9815
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 08917-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2677312Medicaid
OHQ71068Medicare UPIN
OH2677312Medicaid