Provider Demographics
NPI:1518565183
Name:LAWRENCE, TAMARA JESSICA
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:JESSICA
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 1:1482 LINCOLN PL APT 7
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-4137
Mailing Address - Country:US
Mailing Address - Phone:347-265-2461
Mailing Address - Fax:
Practice Address - Street 1:1482 LINCOLN PL APT 7
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-4137
Practice Address - Country:US
Practice Address - Phone:347-265-2461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339084164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse