Provider Demographics
NPI:1326634304
Name:LAWSON, JACQUELINE YVONNE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:YVONNE
Last Name:LAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:MICHAEL
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:887 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-3110
Mailing Address - Country:US
Mailing Address - Phone:503-623-4440
Mailing Address - Fax:
Practice Address - Street 1:887 MAIN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-3110
Practice Address - Country:US
Practice Address - Phone:503-623-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR96006087RN163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator