Provider Demographics
NPI:1053782110
Name:LAWRENCE, CINDY
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
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:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VILLAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:134 REYNOLDS ROAD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VILLAGE
Practice Address - State:AK
Practice Address - Zip Code:99632
Practice Address - Country:US
Practice Address - Phone:907-591-2926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker