Provider Demographics
NPI:1124150073
Name:LAWLESS, ANDREA DIANNE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:DIANNE
Last Name:LAWLESS
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 1:2041 SE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-1566
Mailing Address - Country:US
Mailing Address - Phone:515-864-9009
Mailing Address - Fax:
Practice Address - Street 1:2041 SE 5TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-1566
Practice Address - Country:US
Practice Address - Phone:515-864-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0427963Medicaid