Provider Demographics
NPI:1649528738
Name:LAWRENCE, CAROL (BS)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2604 KERRY LN
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-2159
Mailing Address - Country:US
Mailing Address - Phone:405-476-9695
Mailing Address - Fax:
Practice Address - Street 1:7905 E US HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-9225
Practice Address - Country:US
Practice Address - Phone:405-264-5555
Practice Address - Fax:405-264-5502
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator