Provider Demographics
NPI:1508007287
Name:LAWRENCE, MARLO RUTH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARLO
Middle Name:RUTH
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12934 WESTELLA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3704
Mailing Address - Country:US
Mailing Address - Phone:786-853-9037
Mailing Address - Fax:
Practice Address - Street 1:9329 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1512
Practice Address - Country:US
Practice Address - Phone:786-853-9037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9104696363AM0700X
TXPA09022363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical