Provider Demographics
NPI:1760796148
Name:SLAWSON, LISA NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:NICOLE
Last Name:SLAWSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 BIENVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5702
Mailing Address - Country:US
Mailing Address - Phone:228-818-9620
Mailing Address - Fax:228-818-9750
Practice Address - Street 1:3603 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5702
Practice Address - Country:US
Practice Address - Phone:228-818-9620
Practice Address - Fax:228-818-9750
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-106412363L00000X
MSR893861363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-106412OtherALABAMA LICENSE
MSR893861OtherMISSISSIPPI LICENSE