Healthcare Provider Details

I. General information

NPI: 1982482006
Provider Name (Legal Business Name): CORTNEY BREANNE LAWSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8762
US

IV. Provider business mailing address

48 EVERGREEN AVE
CLOVIS CA
93611-0643
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-5480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95025879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: