Provider Demographics
NPI:1639231426
Name:LAWRENCE, ADDIE (NP)
Entity Type:Individual
Prefix:
First Name:ADDIE
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1086
Mailing Address - Country:US
Mailing Address - Phone:508-756-1808
Mailing Address - Fax:508-756-1808
Practice Address - Street 1:416 BELMONT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1086
Practice Address - Country:US
Practice Address - Phone:508-756-1808
Practice Address - Fax:508-756-1808
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA264754363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0710211Medicaid
MA9771476Medicaid
MAM20928OtherGROUP MEDICARE