Provider Demographics
NPI:1366431496
Name:LAWSON, EILEEN I (PAC)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:I
Last Name:LAWSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:M
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:9474 HWY 111
Mailing Address - Street 2:
Mailing Address - City:ANACOCO
Mailing Address - State:LA
Mailing Address - Zip Code:71403-4423
Mailing Address - Country:US
Mailing Address - Phone:910-309-7325
Mailing Address - Fax:
Practice Address - Street 1:310 HIGH SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:ST. MARY'S
Practice Address - State:AK
Practice Address - Zip Code:99658
Practice Address - Country:US
Practice Address - Phone:907-438-3517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103088363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP18033Medicaid
P18033Medicare UPIN
2753037AMedicare Oscar/Certification