Provider Demographics
NPI:1497706345
Name:MASON, NOREEN C (ARNP MSN)
Entity Type:Individual
Prefix:MRS
First Name:NOREEN
Middle Name:C
Last Name:MASON
Suffix:
Gender:F
Credentials:ARNP MSN
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Mailing Address - Street 1:501 E BROADWAY
Mailing Address - Street 2:SUITE 290
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1785
Mailing Address - Country:US
Mailing Address - Phone:502-217-8221
Mailing Address - Fax:502-217-5056
Practice Address - Street 1:215 CENTRAL AVE STE 102
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1450
Practice Address - Country:US
Practice Address - Phone:502-852-7449
Practice Address - Fax:502-852-1423
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY4179P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78011244Medicaid
KY0048458Medicare PIN
KY78011244Medicaid
KYP400025747Medicare PIN
KY0523970Medicare PIN