Provider Demographics
NPI:1881667533
Name:LAWRENCE, MONICA (PA)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3815 E BELL RD STE 2200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2139
Mailing Address - Country:US
Mailing Address - Phone:602-633-3848
Mailing Address - Fax:602-633-3841
Practice Address - Street 1:10815 W MCDOWELL RD STE 202
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5010
Practice Address - Country:US
Practice Address - Phone:623-433-0202
Practice Address - Fax:623-433-0204
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00859363A00000X
WAPA60317852363A00000X
AZ7879363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01257181OtherRR MEDICARE
WA315439OtherL&I POST 7/21/13
WA1881667533Medicaid
WAP01257181OtherRR MEDICARE
WAP01257181OtherRR MEDICARE
WAG8920076, G8920077Medicare PIN
WA315439OtherL&I POST 7/21/13
KS042912Medicare ID - Type Unspecified