Provider Demographics
NPI:1881300150
Name:LAWRENCE, AYANNA (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:AYANNA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1121
Mailing Address - Country:US
Mailing Address - Phone:410-419-0906
Mailing Address - Fax:
Practice Address - Street 1:8200 PERRY HALL BLVD STE 138
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-4901
Practice Address - Country:US
Practice Address - Phone:410-258-5548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2177771744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1744P3200XMedicaid