Provider Demographics
NPI: | 1851086888 |
---|---|
Name: | CRUMRINE, MASON (AGACNP) |
Entity Type: | Individual |
Prefix: | |
First Name: | MASON |
Middle Name: | |
Last Name: | CRUMRINE |
Suffix: | |
Gender: | F |
Credentials: | AGACNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 2129 |
Mailing Address - Street 2: | |
Mailing Address - City: | ODESSA |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 79760-2129 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 432-640-6446 |
Mailing Address - Fax: | 432-640-6491 |
Practice Address - Street 1: | 519 N LINCOLN AVE |
Practice Address - Street 2: | |
Practice Address - City: | ODESSA |
Practice Address - State: | TX |
Practice Address - Zip Code: | 79761-4429 |
Practice Address - Country: | US |
Practice Address - Phone: | 432-640-6446 |
Practice Address - Fax: | 432-640-6491 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2023-04-06 |
Last Update Date: | 2023-04-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 1112586 | 363LG0600X, 363L00000X, 363LA2100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
No | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |