Healthcare Provider Details

I. General information

NPI: 1821852948
Provider Name (Legal Business Name): MASON JAMES NADEAU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3061 HIGHWAY 281 UNIT 819
DUNSEITH ND
58329-7400
US

IV. Provider business mailing address

PO BOX 1123
DUNSEITH ND
58329-1123
US

V. Phone/Fax

Practice location:
  • Phone: 701-389-8648
  • Fax:
Mailing address:
  • Phone: 701-389-8648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: