Provider Demographics
NPI:1942773726
Name:LAWRENCE, THAO DIEN (FNP-C)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:DIEN
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 E ANNETTE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-9558
Mailing Address - Country:US
Mailing Address - Phone:818-484-1966
Mailing Address - Fax:
Practice Address - Street 1:4605 E ANNETTE DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-9558
Practice Address - Country:US
Practice Address - Phone:818-484-1966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ218136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily