Provider Demographics
NPI:1205358504
Name:LAWSON, JENNIFER VICTORIA (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:VICTORIA
Last Name:LAWSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:VICTORIA
Other - Last Name:BYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8701 OLD TROY PIKE
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1066
Mailing Address - Country:US
Mailing Address - Phone:937-233-7146
Mailing Address - Fax:
Practice Address - Street 1:752 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-8944
Practice Address - Country:US
Practice Address - Phone:937-208-6865
Practice Address - Fax:937-208-6868
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2565399Medicaid
OH3125746Medicaid