Provider Demographics
NPI:1689346165
Name:BEAN, LAWRENCE ALLEN (HIS, RN)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ALLEN
Last Name:BEAN
Suffix:
Gender:M
Credentials:HIS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 W GRAND PKWY S STE 900
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8311
Mailing Address - Country:US
Mailing Address - Phone:832-437-6566
Mailing Address - Fax:
Practice Address - Street 1:1575 W GRAND PKWY S STE 900
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8311
Practice Address - Country:US
Practice Address - Phone:832-437-6566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX729551163WC0200X
TX80971237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80971OtherTEXAS DEPARTMENT OF LICENSE REGISTRATION