Provider Demographics
NPI:1457611543
Name:MASON, CHANTELL (LVN)
Entity Type:Individual
Prefix:MS
First Name:CHANTELL
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 BOGIE WAY
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-3687
Mailing Address - Country:US
Mailing Address - Phone:830-433-7626
Mailing Address - Fax:
Practice Address - Street 1:3818 BOGIE WAY
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-3687
Practice Address - Country:US
Practice Address - Phone:830-433-7626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor