Provider Demographics
NPI:1447792080
Name:LAWRENCE, ANGELA JULIA (HOME HEALTH CARE)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JULIA
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:HOME HEALTH CARE
Other - Prefix:
Other - First Name:OWEN
Other - Middle Name:JOHN
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HOME HEALTH CARE
Mailing Address - Street 1:8032 MECHANICSVILLE TPKE
Mailing Address - Street 2:8 032MECHANICSVILLE TURNPIKE
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-1223
Mailing Address - Country:US
Mailing Address - Phone:804-559-0322
Mailing Address - Fax:804-559-0344
Practice Address - Street 1:8032 MECHANICSVILLE TPKE
Practice Address - Street 2:8032 MECHANICSVILLE TURNPIKE
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1223
Practice Address - Country:US
Practice Address - Phone:804-559-0322
Practice Address - Fax:804-559-0344
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO17726163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1093042723Medicaid