Healthcare Provider Details

I. General information

NPI: 1073968657
Provider Name (Legal Business Name): LEZLIE MALSON F.N.P.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 N WEST AVE
JACKSON MI
49201-1903
US

IV. Provider business mailing address

2628 WHITE RD
CEMENT CITY MI
49233-9533
US

V. Phone/Fax

Practice location:
  • Phone: 517-784-9189
  • Fax: 517-780-9238
Mailing address:
  • Phone: 517-784-9189
  • Fax: 517-780-9239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704265875
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: