Provider Demographics
NPI:1881276855
Name:MASON, BREANNA JADE (LVN)
Entity type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:JADE
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 1:1463 FM 304
Mailing Address - Street 2:
Mailing Address - City:DIBOLL
Mailing Address - State:TX
Mailing Address - Zip Code:75941-5203
Mailing Address - Country:US
Mailing Address - Phone:936-404-8722
Mailing Address - Fax:
Practice Address - Street 1:1463 FM 304
Practice Address - Street 2:
Practice Address - City:DIBOLL
Practice Address - State:TX
Practice Address - Zip Code:75941-5203
Practice Address - Country:US
Practice Address - Phone:936-404-8722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX352748164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse