Provider Demographics
NPI:1134729395
Name:LAWRENCE, ALISA
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:
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 1:3860 JULIA CT
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4133
Mailing Address - Country:US
Mailing Address - Phone:614-937-7706
Mailing Address - Fax:
Practice Address - Street 1:3860 JULIA CT
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-4133
Practice Address - Country:US
Practice Address - Phone:614-937-7706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health