Individual
ELLYN M LAWRENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16820 81ST CT APT 3S, TINLEY PARK, IL 60477-2044
(708) 704-9671
Mailing address
16820 81ST CT APT 3S, TINLEY PARK, IL 60477-2044
(708) 704-9671
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VUE822511480
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/02/2022
Last updated
08/02/2022
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