Provider Demographics
NPI:1538467519
Name:LAWSON, SHANNON LEE (PA)
Entity Type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:LEE
Last Name:LAWSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:4100 SARA RD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1025
Practice Address - Country:US
Practice Address - Phone:505-253-7900
Practice Address - Fax:505-893-8000
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06906363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12253854OtherCAQH
TXPA06906OtherMEDICAL LICENSE
TX30178591OtherDPS
TX30178591OtherDPS