Provider Demographics
NPI:1851650121
Name:LAWRENCE, ZELLATESIA SHION
Entity Type:Individual
Prefix:MRS
First Name:ZELLATESIA
Middle Name:SHION
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12427 ROBBIE AVE.
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815
Mailing Address - Country:US
Mailing Address - Phone:225-221-8505
Mailing Address - Fax:
Practice Address - Street 1:12427 ROBBIE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-2693
Practice Address - Country:US
Practice Address - Phone:225-221-8505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008352011347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle