Provider Demographics
NPI:1922117738
Name:LAWRENCE, MARY ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY ELLEN
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LOS GATOS LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4258
Mailing Address - Country:US
Mailing Address - Phone:505-629-8260
Mailing Address - Fax:
Practice Address - Street 1:NAZ HOSPITALISTS
Practice Address - Street 2:1003 WILLOW CREEK RD
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305
Practice Address - Country:US
Practice Address - Phone:928-771-5470
Practice Address - Fax:928-771-5471
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42015208M00000X
NMMD2003-0768207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist