Individual
MISS SHANNON LEE LAWSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4100 SARA RD SE, RIO RANCHO, NM 87124-1025
(505) 253-7900
(505) 893-8000
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA06906
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12253854
CAQH
TX
01
—
30178591
DPS
TX
01
—
PA06906
MEDICAL LICENSE
TX
Enumeration date
03/01/2011
Last updated
03/07/2023
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