Healthcare Provider Details

I. General information

NPI: 1609280742
Provider Name (Legal Business Name): EMILY NICOLE LAWSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 W PLACITA ESTRELLA AZUL
TUCSON AZ
85713-1595
US

IV. Provider business mailing address

826 W PLACITA ESTRELLA AZUL
TUCSON AZ
85713-1595
US

V. Phone/Fax

Practice location:
  • Phone: 425-829-2840
  • Fax:
Mailing address:
  • Phone: 425-829-2840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOP61036209
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR2399
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: