Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | 1043575780 | NC |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 210237 | NC |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 5005698 | NC |
NPI | 1043575780 |
---|---|
Provider Name | Kimberly Rae Lawrence |
First Address | Greensboro, NC 27407-1638 |
Second Address | Greensboro, NC 27407-1638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2012 |
Last Update Date | 25/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7006194 | (05) | NC |