Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 56057 | NM |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP136365 | TX |
NPI | 1023545076 |
---|---|
Provider Name | Mr. Stephen Lynn Mason |
First Address | Espanola, NM 87532-5511 |
Second Address | Espanola, NM 87532-2687 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2017 |
Last Update Date | 16/07/2019 |