Provider Demographics
NPI:1336914464
Name:LAWRENCE, CARMELLA L
Entity type:Individual
Prefix:PROF
First Name:CARMELLA
Middle Name:L
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 1:9700 MACKENZIE RD STE 225B
Mailing Address - Street 2:
Mailing Address - City:AFFTON
Mailing Address - State:MO
Mailing Address - Zip Code:63123-5560
Mailing Address - Country:US
Mailing Address - Phone:636-898-6994
Mailing Address - Fax:
Practice Address - Street 1:9700 MACKENZIE RD STE 225B
Practice Address - Street 2:
Practice Address - City:AFFTON
Practice Address - State:MO
Practice Address - Zip Code:63123-5560
Practice Address - Country:US
Practice Address - Phone:636-898-6994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 376J00000X, 251E00000X
MO142490376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty