Provider Demographics
NPI:1760015390
Name:LAWS, KEVICHE (RN)
Entity Type:Individual
Prefix:
First Name:KEVICHE
Middle Name:
Last Name:LAWS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6145 ERDRICK ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-3516
Mailing Address - Country:US
Mailing Address - Phone:215-200-6410
Mailing Address - Fax:215-457-6500
Practice Address - Street 1:1103 WINDRIM AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19141-2817
Practice Address - Country:US
Practice Address - Phone:215-457-6400
Practice Address - Fax:215-457-6500
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN622566163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA41663601OtherDEPARTMENT OF HEALTH HOME CARE LICENSE