Provider Demographics
NPI:1750449609
Name:LAWRENCE, MARY HARREL (RN MS ANP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:HARREL
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:RN MS ANP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:HARREL
Other - Last Name:LAWRENCE HOCKING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1940
Mailing Address - Street 2:4313 JUNE PT
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-1840
Mailing Address - Country:US
Mailing Address - Phone:970-949-4060
Mailing Address - Fax:970-949-4060
Practice Address - Street 1:GLENWOOD MEDICAL ASSOCIATES
Practice Address - Street 2:1830 BLAKE
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601
Practice Address - Country:US
Practice Address - Phone:970-945-8503
Practice Address - Fax:970-945-8782
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN40768163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse