Provider Demographics
NPI:1457833741
Name:MASON, HALEY DIANNA (PA-C)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:DIANNA
Last Name:MASON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CRESSON
Mailing Address - State:PA
Mailing Address - Zip Code:16630-1115
Mailing Address - Country:US
Mailing Address - Phone:814-421-7613
Mailing Address - Fax:
Practice Address - Street 1:1701 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-8815
Practice Address - Country:US
Practice Address - Phone:717-843-8623
Practice Address - Fax:717-862-5576
Is Sole Proprietor?:No
Enumeration Date:2018-09-03
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA004596363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant