Provider Demographics
NPI:1861684508
Name:MASON, TAMMY L (LPN)
Entity Type:Individual
Prefix:MISS
First Name:TAMMY
Middle Name:L
Last Name:MASON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:TAMMY
Other - Middle Name:L
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:1209 CURTIS ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-5731
Mailing Address - Country:US
Mailing Address - Phone:513-705-9055
Mailing Address - Fax:
Practice Address - Street 1:1209 CURTIS ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5731
Practice Address - Country:US
Practice Address - Phone:513-705-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN112423164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse