Provider Demographics
NPI:1629840988
Name:MASON, ELISHA RYAAN (CD)
Entity Type:Individual
Prefix:MS
First Name:ELISHA
Middle Name:RYAAN
Last Name:MASON
Suffix:
Gender:F
Credentials:CD
Other - Prefix:MS
Other - First Name:LISSAH
Other - Middle Name:RYAAN
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CD
Mailing Address - Street 1:11915 S RIDGEWAY AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-1485
Mailing Address - Country:US
Mailing Address - Phone:938-227-0046
Mailing Address - Fax:
Practice Address - Street 1:11915 S RIDGEWAY AVE APT 5
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-1485
Practice Address - Country:US
Practice Address - Phone:938-227-0046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000000000374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula