Provider Demographics
NPI:1396358255
Name:LAWRENCE, VYVIAN CHARLENE (DVM)
Entity Type:Individual
Prefix:
First Name:VYVIAN
Middle Name:CHARLENE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 81ST ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-4333
Mailing Address - Country:US
Mailing Address - Phone:630-664-8696
Mailing Address - Fax:
Practice Address - Street 1:5939 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-9604
Practice Address - Country:US
Practice Address - Phone:219-515-6904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL090004455207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine