Provider Demographics
NPI:1134664683
Name:MASON, SHEILA (APRN)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF VETERANS AFFAIRS CLINIC
Mailing Address - Street 2:269 SOUTH 7TH STREET
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301
Mailing Address - Country:US
Mailing Address - Phone:918-713-5452
Mailing Address - Fax:918-713-5491
Practice Address - Street 1:DEPARTMENT OF VETERANS AFFAIRS CLINIC
Practice Address - Street 2:269 SOUTH 7TH STREET
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301
Practice Address - Country:US
Practice Address - Phone:918-713-5452
Practice Address - Fax:918-713-5491
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0047049363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKAG1116138OtherAANP CERTIFICATION NUMBER