Provider Demographics
NPI:1699257683
Name:LAWRENCE, KRISTIN M (LPT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:500 CROWN POINT CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9561
Mailing Address - Country:US
Mailing Address - Phone:530-273-2897
Mailing Address - Fax:530-273-2897
Practice Address - Street 1:500 CROWN POINT CIR STE 100
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-273-2897
Practice Address - Fax:530-273-2897
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA40995167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician