Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 000453 | CT |
N | 222Z00000X | Podiatrist | 000453 | CT |
Y | 213E00000X | Podiatrist | DPM00233 | RI |
Y | 222Z00000X | Podiatrist | DPM00233 | RI |
NPI | 1073547162 |
---|---|
Provider Name | Debra Crider Lawrence |
First Address | Westerly, RI 02891 |
Second Address | Westerly, RI 02891 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 21/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030000233RID1 | ANTHEM (01) | RI |
030880 | HEALTH NET (01) | RI |
030880 | HEATH NET (01) | CT |
T22522 | (02) |