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General NPI Number Information
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NPI Number | 1538467519
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Entity Type | Individual
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Provider Name | SHANNON LEE LAWSON PA
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Gender | Female
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Dates
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Enumeration Date | 03/01/2011
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 4100 SARA RD SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-1025
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Country | US
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Telephone | 505-253-7900
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Fax | 505-893-8000
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Provider Business Mailing Address
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Address Line | PO BOX 26666 PHS PROVIDER ENROLLMENT
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 505-923-6770
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Fax | 505-923-5354
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA06906
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License Number State | TX
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