1629270889 NPI number — PROF. MARJORIE THOMAS LAWSON APRN, FNP

Table of content: PROF. MARJORIE THOMAS LAWSON APRN, FNP (NPI 1629270889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629270889 NPI number — PROF. MARJORIE THOMAS LAWSON APRN, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWSON
Provider First Name:
MARJORIE
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629270889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTBROOK
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04092-2522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-854-1929
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
96 FALMOUTH ST
Provider Second Line Business Practice Location Address:
UNIVERSITY OF SOUTHERN MAINE
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04104-9300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-780-4211
Provider Business Practice Location Address Fax Number:
207-780-4911
Provider Enumeration Date:
06/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R026988 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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