Healthcare Provider Details

I. General information

NPI: 1003118043
Provider Name (Legal Business Name): LINDSEY MARIE LAWLESS MS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2010
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 2ND ST
RICHLAND CENTER WI
53581-1900
US

IV. Provider business mailing address

301 E 2ND ST
RICHLAND CENTER WI
53581-1900
US

V. Phone/Fax

Practice location:
  • Phone: 608-647-6161
  • Fax: 608-647-3178
Mailing address:
  • Phone: 608-647-6161
  • Fax: 608-647-3178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC04408
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2720-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: