Provider Demographics
NPI:1437123221
Name:LAWRENCE, ANITA L (PAC)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:L
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PAC
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 499
Mailing Address - Street 2:
Mailing Address - City:OSSIPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03864-0499
Mailing Address - Country:US
Mailing Address - Phone:603-539-6996
Mailing Address - Fax:603-539-5284
Practice Address - Street 1:3 WATER VILLAGE ROAD
Practice Address - Street 2:
Practice Address - City:OSSIPEE
Practice Address - State:NH
Practice Address - Zip Code:03864-0499
Practice Address - Country:US
Practice Address - Phone:603-539-6996
Practice Address - Fax:603-539-5284
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0399P363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH195183OtherCIGNA
P53483Medicare UPIN
NHAP1671Medicare ID - Type Unspecified