Individual
TEDRA ANN LAWRENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
209 CROSSROADS PL STE 120, MOUNT VERNON, IL 62864-6545
(618) 918-6045
(618) 918-6046
Mailing address
209 CROSSROADS PL STE 120, MOUNT VERNON, IL 62864-6545
(618) 918-6045
(618) 918-6046
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209030718
IL
Other
Enumeration date
10/04/2024
Last updated
12/17/2024
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