Provider Demographics
NPI:1407289010
Name:LAWSON, LESLIE ELIZABETH J (CRNP)
Entity Type:Individual
Prefix:MS
First Name:LESLIE ELIZABETH
Middle Name:J
Last Name:LAWSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BENFIELD BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3004
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:
Practice Address - Street 1:4201 MITCHELLVILLE RD STE 102
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716
Practice Address - Country:US
Practice Address - Phone:301-262-5900
Practice Address - Fax:410-741-0865
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR223943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP01351463OtherRAILROAD MEDICARE
GA003148280AMedicaid
GA003148280BMedicaid
GAP01351463OtherRAILROAD MEDICARE