Provider Demographics
NPI:1902074198
Name:LAWLESS, SHIRLEY ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:ANN
Last Name:LAWLESS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4219 HONEYBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1444
Mailing Address - Country:US
Mailing Address - Phone:937-898-8623
Mailing Address - Fax:937-274-1365
Practice Address - Street 1:4219 HONEYBROOK AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1444
Practice Address - Country:US
Practice Address - Phone:937-898-8623
Practice Address - Fax:937-274-1365
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 121567164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse