Provider Demographics
NPI:1043557697
Name:MASON, KATHRYN ANNE (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ANNE
Last Name:MASON
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Gender:F
Credentials:REGISTERED DIETITIAN
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Mailing Address - Street 1:14045 N 7TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4388
Mailing Address - Country:US
Mailing Address - Phone:623-399-6825
Mailing Address - Fax:623-505-3474
Practice Address - Street 1:17505 N 79TH AVE
Practice Address - Street 2:SUITE 407
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8725
Practice Address - Country:US
Practice Address - Phone:623-399-6825
Practice Address - Fax:623-505-3474
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2016-12-02
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ189393Medicare UPIN