Provider Demographics
NPI:1750476677
Name:LAWLOR, PAMELA J (NP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:J
Last Name:LAWLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10941 RAVEN RIDGE RD # 1
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6487
Mailing Address - Country:US
Mailing Address - Phone:919-847-7475
Mailing Address - Fax:
Practice Address - Street 1:10941 RAVEN RIDGE RD # 1
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6487
Practice Address - Country:US
Practice Address - Phone:919-847-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC278434363LW0102X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC278434OtherBON
NC278434OtherBON
NYS79076Medicare UPIN
NY346842OtherMVP HEALTH PLAN