Provider Demographics
NPI:1154005502
Name:LAWRENCE, MARK (APRN)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3409
Mailing Address - Country:US
Mailing Address - Phone:603-969-3509
Mailing Address - Fax:
Practice Address - Street 1:65 CALEF HWY STE 200
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:NH
Practice Address - Zip Code:03861-6703
Practice Address - Country:US
Practice Address - Phone:603-868-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH082794-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily