Individual
MR. LAWRENCE W CARLSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1050 DELAWARE AVE, MARION, OH 43302-6416
(740) 383-7778
(740) 375-8174
Mailing address
# L-3652, COLUMBUS, OH 43260-6052
(740) 383-7927
(740) 383-7942
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
COA.04689-NA
OH
367500000X
Certified Registered Nurse Anesthetist
RN277926
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000205999
ANTHEM
—
05
—
2150872
—
OH
01
—
430066223
MEDICARE RAILROAD
—
Enumeration date
05/15/2006
Last updated
01/12/2017
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