Provider Demographics
NPI:1578815643
Name:MASON, LYDIA C (FNP)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:C
Last Name:MASON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:FLECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3380 TREMONT RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2112
Mailing Address - Country:US
Mailing Address - Phone:614-442-6647
Mailing Address - Fax:614-442-6648
Practice Address - Street 1:3380 TREMONT RD
Practice Address - Street 2:SUITE 140
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2112
Practice Address - Country:US
Practice Address - Phone:614-442-6647
Practice Address - Fax:614-442-6648
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22298363LF0000X
OH14500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily