Provider Demographics
NPI:1205252624
Name:LAWRENCE, MELANIE D (NP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:D
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:D
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:394 SINGLETON RIDGE RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9150
Practice Address - Country:US
Practice Address - Phone:843-347-8765
Practice Address - Fax:843-347-3499
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18727363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2742Medicaid
SC1118719OtherWELLCARE
SCP01329637OtherRR MEDICARE
SC30177576OtherSELECT HEALTH
SC4895462OtherAETNA
SC80023032OtherSELECT HEALTH
SC1118719OtherWELLCARE