Provider Demographics
NPI:1700583846
Name:LAWRENCE, IRIS
Entity Type:Individual
Prefix:
First Name:IRIS
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 1:8290 MARKLEY RD
Mailing Address - Street 2:
Mailing Address - City:LUDLOW FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:45339-9788
Mailing Address - Country:US
Mailing Address - Phone:937-609-1434
Mailing Address - Fax:
Practice Address - Street 1:8290 MARKLEY RD
Practice Address - Street 2:
Practice Address - City:LUDLOW FALLS
Practice Address - State:OH
Practice Address - Zip Code:45339-9788
Practice Address - Country:US
Practice Address - Phone:937-609-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant