Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | 1103103 | KS |
N | 2251H1200X | Hand | 2002017398 | MO |
NPI | 1245276013 |
---|---|
Provider Name | Marsha B Lawrence |
First Address | Stilwell, KS 66085-9450 |
Second Address | Stilwell, KS 66085-9450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 20/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33424033 | BLUE SHIELD OF KANSAS CIT (01) | MO |