Provider Demographics
NPI:1043257223
Name:LAWSON, JENNIFER EASHOO (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EASHOO
Last Name:LAWSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:EASHOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:208 N SHIAWASSEE ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2755
Mailing Address - Country:US
Mailing Address - Phone:989-725-2667
Mailing Address - Fax:989-729-4032
Practice Address - Street 1:208 N SHIAWASSEE ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2755
Practice Address - Country:US
Practice Address - Phone:989-725-2667
Practice Address - Fax:989-729-4032
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003041363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1043257223Medicaid