Provider Demographics
NPI:1679023022
Name:LAWTON, SALLY RENEE (NP-C)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:RENEE
Last Name:LAWTON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1187
Mailing Address - Country:US
Mailing Address - Phone:740-779-4000
Mailing Address - Fax:
Practice Address - Street 1:55 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1187
Practice Address - Country:US
Practice Address - Phone:740-779-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRNCNP020271363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner