Provider Demographics
NPI:1790749778
Name:MASON, JAYDENE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JAYDENE
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 BELLEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-2334
Mailing Address - Country:US
Mailing Address - Phone:719-384-0184
Mailing Address - Fax:
Practice Address - Street 1:2600 OAKSHIRE LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-5671
Practice Address - Country:US
Practice Address - Phone:719-295-7260
Practice Address - Fax:719-295-7267
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72274363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology