Provider Demographics
NPI:1528017977
Name:MASON, VERONICA V (FNP)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:V
Last Name:MASON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 SAWYER DR STE 6
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-2979
Mailing Address - Country:US
Mailing Address - Phone:716-216-4424
Mailing Address - Fax:716-216-4426
Practice Address - Street 1:2131 SAWYER DR STE 6
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2979
Practice Address - Country:US
Practice Address - Phone:716-216-4424
Practice Address - Fax:716-216-4426
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY455196163W00000X
NY333243363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02213683Medicaid
PENDINGMedicare UPIN
NY02213683Medicaid