Provider Demographics
NPI:1497159032
Name:MASON, ANGELIQUE S (CRNP)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:S
Last Name:MASON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 MANTUA PIKE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1221
Mailing Address - Country:US
Mailing Address - Phone:856-845-8600
Mailing Address - Fax:856-845-4890
Practice Address - Street 1:1006 MANTUA PIKE
Practice Address - Street 2:
Practice Address - City:WOODBURY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08097-1221
Practice Address - Country:US
Practice Address - Phone:856-845-8600
Practice Address - Fax:856-845-4890
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00918200363LF0000X
PASP014311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily