Provider Demographics
NPI:1164417242
Name:MASON, SUSAN JEANNE (APRN,BC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JEANNE
Last Name:MASON
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PINE FORK DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5121
Mailing Address - Country:US
Mailing Address - Phone:732-341-1407
Mailing Address - Fax:
Practice Address - Street 1:LAKEHURST NAVAL HEALTH CLINIC
Practice Address - Street 2:NAES LANSDOWNE RD
Practice Address - City:LAKEHURST
Practice Address - State:NJ
Practice Address - Zip Code:08733-5006
Practice Address - Country:US
Practice Address - Phone:732-323-1490
Practice Address - Fax:732-323-2632
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06466000363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health