=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801758222
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEREMY LAWSON APRN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2025
-----------------------------------------------------
Last Update Date | 11/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3609 PARK EAST DR STE 207
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-4309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-360-0456
-----------------------------------------------------
Fax | 216-360-9449
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3609 PARK EAST DR STE 207
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-4309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-360-0456
-----------------------------------------------------
Fax | 216-360-9449
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.0040903
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------