MEDICARE: CAROL J LAWSON RN CDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WD0400X	Diabetes Educator Registered Nurse	RN138595	AZ

General Provider Information

NPI Number	:	1134694342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL J LAWSON RN CDE

Provider Business Mailing Address
First Line	:	294 W STATE ROUTE 89A STE 102
Second Line	:
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-3763
Country	:	US
Telephone Number	:	928-639-6346
Fax Number	:	928-639-6623

Provider Business Practice Location Address
First Line	:	294 W STATE ROUTE 89A STE 102
Second Line	:
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-3763
Country	:	US
Telephone Number	:	928-639-6346
Fax Number	:	928-639-6623

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2018
Last Update Date	:	10/04/2018

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