Provider Demographics
NPI:1619517208
Name:LAWRENCE, MICHELLE MELISSA
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MELISSA
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 1:12610 CAMBLETON DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1730
Mailing Address - Country:US
Mailing Address - Phone:240-510-4884
Mailing Address - Fax:240-929-4709
Practice Address - Street 1:12610 CAMBLETON DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1730
Practice Address - Country:US
Practice Address - Phone:240-510-4884
Practice Address - Fax:240-929-4709
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16AL1242-A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health