Individual
TIFFANY LAWRENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ASN
Contact information
Practice address
722 SCOTT ST, COVINGTON, KY 41011-2418
(859) 431-3052
(859) 431-3055
Mailing address
722 SCOTT ST, COVINGTON, KY 41011-2418
(859) 431-3052
(859) 431-3055
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
114815
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FEDERAL TAX ID NUMBE
610661458
KY
Enumeration date
10/09/2007
Last updated
10/09/2007
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