Provider Demographics
NPI:1417569732
Name:LAWRENCE, NIKOLE MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:NIKOLE
Middle Name:MARIE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 PINTAIL DR
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-8006
Mailing Address - Country:US
Mailing Address - Phone:307-670-2496
Mailing Address - Fax:
Practice Address - Street 1:430 S MEDICAL ARTS CT
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3364
Practice Address - Country:US
Practice Address - Phone:307-685-6500
Practice Address - Fax:307-685-3081
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY46184363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily