Provider Demographics
NPI:1932286531
Name:LAWRENCE, RAYLENE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RAYLENE
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 LANKY RD
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WA
Mailing Address - Zip Code:99111-8770
Mailing Address - Country:US
Mailing Address - Phone:509-397-4717
Mailing Address - Fax:509-397-3501
Practice Address - Street 1:1210 W FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WA
Practice Address - Zip Code:99111-9552
Practice Address - Country:US
Practice Address - Phone:509-397-4717
Practice Address - Fax:509-397-3501
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004711363A00000X
TXPA06967363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0194084OtherWA STATE DL&I NUMBER
WA8373193Medicaid
WAG8913140Medicare PIN
WA8373193Medicaid