MEDICARE: SAMANTHA LAWSON CNM, WHNP, PMHNP-BC

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	363LW0102X	Women's Health Nurse Practitioner	0024177392	VA
2	367A00000X	Advanced Practice Midwife	0024177392	VA
3	367A00000X	Advanced Practice Midwife	APN.0997973-CNM	CO
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024177392	VA

General Provider Information

NPI Number	:	1780199927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LAWSON CNM, WHNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	2624 SOUTHERN BLVD STE 102
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7433
Country	:	US
Telephone Number	:	757-453-1256
Fax Number	:	319-359-3813

Provider Business Practice Location Address
First Line	:	2624 SOUTHERN BLVD STE 102
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7433
Country	:	US
Telephone Number	:	757-453-1256
Fax Number	:	319-359-3813

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

Provider Enumeration Date	:	12/11/2017
Last Update Date	:	03/11/2024

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