Provider Demographics
NPI:1336949635
Name:LAWRENCE, LAHANAL
Entity type:Individual
Prefix:
First Name:LAHANAL
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 MILLBROOK DR APT C
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-4252
Mailing Address - Country:US
Mailing Address - Phone:336-671-4617
Mailing Address - Fax:
Practice Address - Street 1:2870 MILLBROOK DR APT C
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-4252
Practice Address - Country:US
Practice Address - Phone:336-671-4617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC453029376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty