MEDICARE: LISA NICOLE SLAWSON N.P.

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	363L00000X	Nurse Practitioner	1-106412	AL
2	363L00000X	Nurse Practitioner	R893861	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-106412	OTHER	AL	ALABAMA LICENSE
2	R893861	OTHER	MS	MISSISSIPPI LICENSE

General Provider Information

NPI Number	:	1760796148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA NICOLE SLAWSON N.P.

Provider Business Mailing Address
First Line	:	3603 BIENVILLE BLVD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5702
Country	:	US
Telephone Number	:	228-818-9620
Fax Number	:	228-818-9750

Provider Business Practice Location Address
First Line	:	3603 BIENVILLE BLVD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5702
Country	:	US
Telephone Number	:	228-818-9620
Fax Number	:	228-818-9750

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

Provider Enumeration Date	:	07/28/2010
Last Update Date	:	06/11/2013

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