Provider Demographics
NPI:1376972869
Name:LAWSON, AMANDA (CPNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LAWSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28224 SOUTHPOINTE RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-2024
Mailing Address - Country:US
Mailing Address - Phone:706-247-4939
Mailing Address - Fax:
Practice Address - Street 1:120 WATERSTRADT COMMERCE DR
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-9681
Practice Address - Country:US
Practice Address - Phone:734-823-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704269680363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics