Provider Demographics
NPI:1952900748
Name:LAWRENCE, DANIEL
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 CARLISLE AVE
Mailing Address - Street 2:
Mailing Address - City:MINGO JUNCTION
Mailing Address - State:OH
Mailing Address - Zip Code:43938-1450
Mailing Address - Country:US
Mailing Address - Phone:740-632-8149
Mailing Address - Fax:
Practice Address - Street 1:312 CARLISLE AVE
Practice Address - Street 2:
Practice Address - City:MINGO JUNCTION
Practice Address - State:OH
Practice Address - Zip Code:43938-1450
Practice Address - Country:US
Practice Address - Phone:740-632-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty