Provider Demographics
NPI:1407330996
Name:MASON, TAMARA L (DNP,FNP-C)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:MASON
Suffix:
Gender:F
Credentials:DNP,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 SEYMOUR AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3830
Mailing Address - Country:US
Mailing Address - Phone:307-635-8299
Mailing Address - Fax:307-635-2984
Practice Address - Street 1:2112 SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3830
Practice Address - Country:US
Practice Address - Phone:307-635-8299
Practice Address - Fax:307-635-2984
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY20090.1803363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner