Provider Demographics
NPI:1720828247
Name:LAWSON, NICOLE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LAWSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40491
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-0009
Mailing Address - Country:US
Mailing Address - Phone:585-698-6963
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 40491
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-0009
Practice Address - Country:US
Practice Address - Phone:585-698-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY711640163W00000X
TX1141204163W00000X, 363L00000X
NY353111363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse