Provider Demographics
NPI:1649725136
Name:LAWSON, STORM FALCON (LPN)
Entity type:Individual
Prefix:MR
First Name:STORM
Middle Name:FALCON
Last Name:LAWSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-1534
Mailing Address - Country:US
Mailing Address - Phone:516-617-6125
Mailing Address - Fax:
Practice Address - Street 1:16 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-1534
Practice Address - Country:US
Practice Address - Phone:516-617-6125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32578-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse