Healthcare Provider Details

I. General information

NPI: 1790067429
Provider Name (Legal Business Name): REDA LYNN LAWSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PARKS STREET
MANCHESTER TN
37355
US

IV. Provider business mailing address

297 RIGNEY DRIVE
MANCHESTER TN
37355
US

V. Phone/Fax

Practice location:
  • Phone: 931-723-5134
  • Fax:
Mailing address:
  • Phone: 423-645-9116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000096157
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: