Provider Demographics
NPI:1063453173
Name:MASON, NATHAN M (ARNP)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:M
Last Name:MASON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9840 E LEAVENWORTH RD
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-9313
Mailing Address - Country:US
Mailing Address - Phone:509-548-7987
Mailing Address - Fax:
Practice Address - Street 1:2730 S AVENUE B
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6903
Practice Address - Country:US
Practice Address - Phone:928-344-9166
Practice Address - Fax:928-344-9168
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004609363LF0000X
AZAP2310363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9623687Medicaid
WA9623687Medicaid
AZZ116819Medicare UPIN