Provider Demographics
NPI:1326073511
Name:MASON, ADELAIDE CARY (RN)
Entity Type:Individual
Prefix:MRS
First Name:ADELAIDE
Middle Name:CARY
Last Name:MASON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 MONUMENT AVE
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-3652
Mailing Address - Country:US
Mailing Address - Phone:804-861-0796
Mailing Address - Fax:
Practice Address - Street 1:111 MORTON AVE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2749
Practice Address - Country:US
Practice Address - Phone:804-862-8004
Practice Address - Fax:804-862-6158
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001196197163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult