Provider Demographics
NPI:1467879247
Name:LAWRENCE, MIRIAM DANIELLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:DANIELLE
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 1:61 CINNAMON DR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-1672
Mailing Address - Country:US
Mailing Address - Phone:501-834-1242
Mailing Address - Fax:
Practice Address - Street 1:305 W FRONT ST
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-3119
Practice Address - Country:US
Practice Address - Phone:501-676-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003996363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily