Provider Demographics
NPI:1720967995
Name:NUNLEY, MASON EUGENE
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:EUGENE
Last Name:NUNLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 BROWNING AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5761
Mailing Address - Country:US
Mailing Address - Phone:503-374-8100
Mailing Address - Fax:
Practice Address - Street 1:387 BROWNING AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5761
Practice Address - Country:US
Practice Address - Phone:503-374-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3936359146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic