Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD61075786 | WA |
N | 207Q00000X | Family Doctor | ML60969726 | WA |
N | 207Q00000X | Family Doctor | MT209044 | PA |
NPI | 1003295817 |
---|---|
Provider Name | Dr. Jennifer D Lawrence |
First Address | Mount Vernon, WA 98274-4127 |
Second Address | Stanwood, WA 98292-8071 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2015 |
Last Update Date | 05/08/2021 |