Healthcare Provider Details

I. General information

NPI: 1861406381
Provider Name (Legal Business Name): MELISSA ANN LAWSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 MEDIC WAY
GREENCASTLE IN
46135-2296
US

IV. Provider business mailing address

402 N VINE ST
PLAINFIELD IN
46168-1032
US

V. Phone/Fax

Practice location:
  • Phone: 765-653-2669
  • Fax: 765-653-8671
Mailing address:
  • Phone: 317-430-2973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: