1750449609 NPI number — MS. MARY HARREL LAWRENCE RN MS ANP

Table of content: MS. MARY HARREL LAWRENCE RN MS ANP (NPI 1750449609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750449609 NPI number — MS. MARY HARREL LAWRENCE RN MS ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWRENCE
Provider First Name:
MARY
Provider Middle Name:
HARREL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN MS ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAWRENCE HOCKING
Provider Other First Name:
MARY
Provider Other Middle Name:
HARREL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750449609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1940
Provider Second Line Business Mailing Address:
4313 JUNE PT
Provider Business Mailing Address City Name:
AVON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81620-1840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-949-4060
Provider Business Mailing Address Fax Number:
970-949-4060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GLENWOOD MEDICAL ASSOCIATES
Provider Second Line Business Practice Location Address:
1830 BLAKE
Provider Business Practice Location Address City Name:
GLENWOOD SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-945-8503
Provider Business Practice Location Address Fax Number:
970-945-8782
Provider Enumeration Date:
12/04/2006

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: 163W00000X , with the licence number:  RN40768 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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