Provider Demographics
NPI:1134381635
Name:MASON, LASANDRA MARIA (CERTIFIED NURSING AS)
Entity type:Individual
Prefix:MS
First Name:LASANDRA
Middle Name:MARIA
Last Name:MASON
Suffix:
Gender:F
Credentials:CERTIFIED NURSING AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 34TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-3512
Mailing Address - Country:US
Mailing Address - Phone:757-236-4207
Mailing Address - Fax:
Practice Address - Street 1:1006 34TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-3512
Practice Address - Country:US
Practice Address - Phone:757-236-4207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401087548376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide