Provider Demographics
NPI:1750428306
Name:LAWRENCE, TAMMY RUTH (LSA)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:RUTH
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 SAN DIEGO ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8523
Mailing Address - Country:US
Mailing Address - Phone:432-275-0511
Mailing Address - Fax:
Practice Address - Street 1:8220 SAN DIEGO ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8523
Practice Address - Country:US
Practice Address - Phone:432-275-0511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00015246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist