Provider Demographics
NPI:1043559040
Name:NASH, MARK CORNARDO
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CORNARDO
Last Name:NASH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 NW KINYON AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5130
Mailing Address - Country:US
Mailing Address - Phone:580-284-5824
Mailing Address - Fax:
Practice Address - Street 1:3504 NW KINYON AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5130
Practice Address - Country:US
Practice Address - Phone:580-284-5824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor