Provider Demographics
NPI:1508520719
Name:LAWRENCE, TEESHELL KANTRELL
Entity Type:Individual
Prefix:
First Name:TEESHELL
Middle Name:KANTRELL
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3553
Mailing Address - Country:US
Mailing Address - Phone:504-896-2345
Mailing Address - Fax:504-896-2240
Practice Address - Street 1:1538 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3553
Practice Address - Country:US
Practice Address - Phone:504-896-2345
Practice Address - Fax:504-896-2240
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist