Provider Demographics
NPI:1003250341
Name:LAWRENCE, MICHELEE
Entity type:Individual
Prefix:
First Name:MICHELEE
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 CLIFFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44904-1501
Mailing Address - Country:US
Mailing Address - Phone:419-756-9124
Mailing Address - Fax:
Practice Address - Street 1:611 CLIFFSIDE DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44904-1501
Practice Address - Country:US
Practice Address - Phone:419-756-9124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN285366163W00000X, 163WC0400X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health