Provider Demographics
NPI:1518329895
Name:MASCARELLO, NICOLE (LVN,CPM,LM)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MASCARELLO
Suffix:
Gender:F
Credentials:LVN,CPM,LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 E MOORE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589
Mailing Address - Country:US
Mailing Address - Phone:956-747-1896
Mailing Address - Fax:
Practice Address - Street 1:904 E MOORE RD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-5204
Practice Address - Country:US
Practice Address - Phone:956-747-1896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329641164X00000X
TX99292176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No164X00000XNursing Service ProvidersLicensed Vocational Nurse