Provider Demographics
NPI:1457083263
Name:LAWSON, MIRANDA D
Entity Type:Individual
Prefix:MISS
First Name:MIRANDA
Middle Name:D
Last Name:LAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 W PINE AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-4132
Mailing Address - Country:US
Mailing Address - Phone:580-747-4281
Mailing Address - Fax:
Practice Address - Street 1:2002 W PINE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-4132
Practice Address - Country:US
Practice Address - Phone:580-747-4281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator