Provider Demographics
NPI:1306735360
Name:MEAD, MARK LAWRENCE (RN)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:LAWRENCE
Last Name:MEAD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35316 THORPE TRL
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-6240
Mailing Address - Country:US
Mailing Address - Phone:909-557-8270
Mailing Address - Fax:
Practice Address - Street 1:3950 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3517
Practice Address - Country:US
Practice Address - Phone:951-358-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95124546163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN95124546OtherRN