Provider Demographics
NPI:1659503506
Name:LAWRENCE, DIANE HELEN (NP)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:HELEN
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:1603 W OLD SHAKOPEE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3065
Mailing Address - Country:US
Mailing Address - Phone:952-767-3294
Mailing Address - Fax:952-767-0018
Practice Address - Street 1:701 DELLWOOD ST S
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1920
Practice Address - Country:US
Practice Address - Phone:763-689-8700
Practice Address - Fax:763-688-7941
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR 153275-5363LP0808X
MN2009006246363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health