Healthcare Provider Details

I. General information

NPI: 1417001348
Provider Name (Legal Business Name): MICHAEL ALBERT LASON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 GATEWAY WEST
EL PASO TX
79925
US

IV. Provider business mailing address

521 ROSINANTE RD
EL PASO TX
79922-2225
US

V. Phone/Fax

Practice location:
  • Phone: 915-595-9628
  • Fax:
Mailing address:
  • Phone: 915-740-4918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number536207
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: