Provider Demographics
NPI:1346626785
Name:LAWLOR, MELISSA (CNM)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LAWLOR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 FOREST RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7371
Mailing Address - Country:US
Mailing Address - Phone:845-705-3344
Mailing Address - Fax:
Practice Address - Street 1:59 FOREST RIDGE RD
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-7371
Practice Address - Country:US
Practice Address - Phone:845-705-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-08
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001698367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife