MEDICARE: GLORY LAWSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1100425	TX

General Provider Information

NPI Number	:	1306919410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORY LAWSON

Provider Business Mailing Address
First Line	:	PO BOX 2173
Second Line	:
City	:	BELLAIRE
State	:	TX
Zip	:	77402-2173
Country	:	US
Telephone Number	:	832-882-0597
Fax Number	:

Provider Business Practice Location Address
First Line	:	19901 SOUTHWEST FWY
Second Line	:	SUITE 131
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-6538
Country	:	US
Telephone Number	:	281-493-5520
Fax Number	:	281-341-1474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	12/08/2022

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