Provider Demographics
NPI:1518387513
Name:LAWSON, GLADYS DIANE (RN)
Entity type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:DIANE
Last Name:LAWSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:GLADYS
Other - Middle Name:DIANE
Other - Last Name:MARTHERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, LPN
Mailing Address - Street 1:124 MALLARD ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-4046
Mailing Address - Country:US
Mailing Address - Phone:864-241-1040
Mailing Address - Fax:864-241-8189
Practice Address - Street 1:124 MALLARD ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-4046
Practice Address - Country:US
Practice Address - Phone:864-241-1040
Practice Address - Fax:864-241-8189
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC213515163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301100Medicaid
SC301100Medicaid