Basic Information
| Provider Information | |||||||||
| NPI: | 1073163812 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAWRENCE | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | BROOKE | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10208 CERNY ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276171000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193547077 | ||||||||
| FaxNumber: | 9193547075 | ||||||||
| Practice Location | |||||||||
| Address1: | 10208 CERNY ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276171000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193547077 | ||||||||
| FaxNumber: | 9193547075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2019 | ||||||||
| LastUpdateDate: | 09/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5012268 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.