Provider Demographics
NPI:1740379882
Name:LAWSON, MARIE DARLENE (CNM)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:DARLENE
Last Name:LAWSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:335A W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-8111
Practice Address - Country:US
Practice Address - Phone:980-487-2870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC88596367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMW0201Medicaid
NC1740379882Medicaid
NC7002115Medicaid
NC89012KHMedicaid
NC012KHOtherBCBS PRACTICE ID
SCMW0201Medicaid
NC89012KHMedicaid
NC7002115Medicaid