Provider Demographics
NPI:1619248937
Name:LAWRICK, GINA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:LAWRICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:50 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013-1246
Mailing Address - Country:US
Mailing Address - Phone:269-427-7937
Mailing Address - Fax:269-427-5180
Practice Address - Street 1:800 M 139
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-3881
Practice Address - Country:US
Practice Address - Phone:269-927-5400
Practice Address - Fax:269-982-5113
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2012-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
363AM0700X
MI5601006200363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical