Provider Demographics
NPI:1184617334
Name:LAWLOR, MARY (CRNA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:LAWLOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 S BERNARD ST # 200
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2509
Mailing Address - Country:US
Mailing Address - Phone:509-456-8150
Mailing Address - Fax:509-455-9887
Practice Address - Street 1:427 S BERNARD ST # 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2509
Practice Address - Country:US
Practice Address - Phone:509-456-8150
Practice Address - Fax:509-455-9887
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00092406163W00000X
WAAP30003785367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA430030686OtherRAILROAD MEDICARE
ID1184617334Medicaid
WA1184617334Medicaid
WA171305OtherLABOR AND INDUSTRIES
ID1184617334Medicaid
WA171305OtherLABOR AND INDUSTRIES
WAS10301Medicare UPIN