Provider Demographics
NPI:1316185192
Name:MASON, JENNIFER LE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LE
Last Name:MASON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BALTIMORE
Mailing Address - State:OH
Mailing Address - Zip Code:45872-1135
Mailing Address - Country:US
Mailing Address - Phone:419-957-6649
Mailing Address - Fax:
Practice Address - Street 1:304 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH BALTIMORE
Practice Address - State:OH
Practice Address - Zip Code:45872-1135
Practice Address - Country:US
Practice Address - Phone:419-957-6649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-01
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 128159 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse