Provider Demographics
NPI:1063068088
Name:LAWRENCE, MALORI (APRN)
Entity type:Individual
Prefix:
First Name:MALORI
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:OK
Mailing Address - Zip Code:73052-5633
Mailing Address - Country:US
Mailing Address - Phone:405-756-1414
Mailing Address - Fax:405-756-1162
Practice Address - Street 1:707 W COMANCHE
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:OK
Practice Address - Zip Code:73052
Practice Address - Country:US
Practice Address - Phone:405-756-1414
Practice Address - Fax:405-756-1162
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK122446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily