Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FC0800X | Contact Lens | L652465138552 |
NPI | 1235697228 |
---|---|
Provider Name | Keyarah Denise Lawrence-Brown I |
First Address | Detroit, MI 48205-1516 |
Second Address | Detroit, MI 48205-1516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2019 |
Last Update Date | 08/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L652465139552 | NONE (01) | MI |