Provider Demographics
NPI:1538819735
Name:MASON, DIANE SYLVIA
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:SYLVIA
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 D ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-6132
Mailing Address - Country:US
Mailing Address - Phone:202-361-4430
Mailing Address - Fax:
Practice Address - Street 1:4325A KANSAS AVE NW # 22
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-7221
Practice Address - Country:US
Practice Address - Phone:202-291-1216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant