1194292268 NPI number — DR. CLARISSA M LAWRENCE DNP, APNP, FNP-BC

Table of content: DR. CLARISSA M LAWRENCE DNP, APNP, FNP-BC (NPI 1194292268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194292268 NPI number — DR. CLARISSA M LAWRENCE DNP, APNP, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWRENCE
Provider First Name:
CLARISSA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP, APNP, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAWRENCE
Provider Other First Name:
CLARISSA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DNP, APNP, FNP-BC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1194292268
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7929 N 76TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53223-3947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-554-9774
Provider Business Mailing Address Fax Number:
414-979-0325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7929 N 76TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53223-3947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-554-9774
Provider Business Practice Location Address Fax Number:
414-979-0325
Provider Enumeration Date:
10/26/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  8814-33 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)