Basic Information
| Provider Information | |||||||||
| NPI: | 1821298118 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAWRENCE | ||||||||
| FirstName: | ANGELENE | ||||||||
| MiddleName: | MICHAELE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MINER | ||||||||
| OtherFirstName: | ANGELENE | ||||||||
| OtherMiddleName: | MICHAELE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1155 MILL ST | ||||||||
| Address2: | K8 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759824097 | ||||||||
| FaxNumber: | 7759825240 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 MCCABE DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895115924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759822862 | ||||||||
| FaxNumber: | 7759822865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2007 | ||||||||
| LastUpdateDate: | 04/01/2013 | ||||||||
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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 | 2084P0800X | 11759 | NV | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 11976606 | 01 | CAQH | OTHER | 11759 | 01 | NV | STATE LICENSE | OTHER |