Provider Demographics
NPI:1841331758
Name:LAWRENCE, SUZANNE CAROL (RN, MSN, FNP)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:CAROL
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 GOLD WAY
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-5647
Mailing Address - Country:US
Mailing Address - Phone:707-586-9360
Mailing Address - Fax:
Practice Address - Street 1:1116 B ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-4054
Practice Address - Country:US
Practice Address - Phone:707-781-6926
Practice Address - Fax:707-762-2145
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN469294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily