Provider Demographics
NPI:1871844373
Name:LAWTON, BOLIVIA DESHAWN (CNA)
Entity Type:Individual
Prefix:MS
First Name:BOLIVIA
Middle Name:DESHAWN
Last Name:LAWTON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24875 PRIELIPP RD APT 1121
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7789
Mailing Address - Country:US
Mailing Address - Phone:951-239-5515
Mailing Address - Fax:951-412-4148
Practice Address - Street 1:24875 PRIELIPP RD APT 1121
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7789
Practice Address - Country:US
Practice Address - Phone:951-239-5515
Practice Address - Fax:951-412-4148
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 3747P1801X, 3747A0650X, 376J00000X
CA00349628376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No376K00000XNursing Service Related ProvidersNurse's Aide
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker