Provider Demographics
NPI:1942067905
Name:LAWRENCE, RAYSHANDA LANORE
Entity Type:Individual
Prefix:
First Name:RAYSHANDA
Middle Name:LANORE
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 1:1383 E MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-2059
Mailing Address - Country:US
Mailing Address - Phone:810-422-9819
Mailing Address - Fax:810-255-4522
Practice Address - Street 1:1383 E MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-2059
Practice Address - Country:US
Practice Address - Phone:810-422-9819
Practice Address - Fax:810-255-4522
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker