Provider Demographics
NPI:1407482607
Name:MASON, PATRICIA MELODIE (RNFA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MELODIE
Last Name:MASON
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 MOORE PL SW
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-5818
Mailing Address - Country:US
Mailing Address - Phone:703-999-3883
Mailing Address - Fax:
Practice Address - Street 1:13890 BRADDOCK RD STE 201
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2437
Practice Address - Country:US
Practice Address - Phone:703-988-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001204668163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant