Individual
DOMINIQUE ANN LAWRENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1085
AK
363AM0700X
Medical Physician Assistant
Primary
PA10222
TX
Other
Enumeration date
10/11/2012
Last updated
11/23/2015
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