Provider Demographics
NPI:1053811281
Name:LAWSON, MARY AILEEN (ACNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:AILEEN
Last Name:LAWSON
Suffix:
Gender:
Credentials:ACNP
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 1379
Mailing Address - Street 2:
Mailing Address - City:MERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97532-1379
Mailing Address - Country:US
Mailing Address - Phone:951-235-7362
Mailing Address - Fax:
Practice Address - Street 1:212 SE 8TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-3016
Practice Address - Country:US
Practice Address - Phone:951-235-7362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95006870363LA2100X
OR201811473NP-PP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care