Provider Demographics
NPI:1518099902
Name:MASON, LEILANI JANE (CNM)
Entity Type:Individual
Prefix:MS
First Name:LEILANI
Middle Name:JANE
Last Name:MASON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:LEILANI
Other - Middle Name:JANE
Other - Last Name:MASON SMIEJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:615-936-2000
Mailing Address - Fax:
Practice Address - Street 1:719 THOMPSON LANE
Practice Address - Street 2:SUITE 27100
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204
Practice Address - Country:US
Practice Address - Phone:615-875-0636
Practice Address - Fax:615-343-6724
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI114433367A00000X
TN7976887367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43969400Medicaid
P75342Medicare UPIN
WI095S 73-601Medicare ID - Type UnspecifiedMILWAUKEE COUNTY