Provider Demographics
NPI:1083805287
Name:BURZYNSKA-MASON, MONIKA
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:BURZYNSKA-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 1:805 AIRPORT WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-6039
Mailing Address - Country:US
Mailing Address - Phone:907-456-8901
Mailing Address - Fax:907-452-5171
Practice Address - Street 1:805 AIRPORT WAY
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-6039
Practice Address - Country:US
Practice Address - Phone:907-456-8901
Practice Address - Fax:907-452-5171
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH0157Medicaid
AKK0000WCHCPMedicare PIN