Provider Demographics
NPI:1639658586
Name:LAWRENCE, VIRGINIA ESTELLE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:ESTELLE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2808
Mailing Address - Country:US
Mailing Address - Phone:631-321-8337
Mailing Address - Fax:631-321-9347
Practice Address - Street 1:38 JAMES ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2808
Practice Address - Country:US
Practice Address - Phone:621-321-8337
Practice Address - Fax:631-321-9347
Is Sole Proprietor?:No
Enumeration Date:2018-08-11
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308865363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health