Provider Demographics
NPI:1790139632
Name:MASON, BETHANIE PATRICIA
Entity Type:Individual
Prefix:MISS
First Name:BETHANIE
Middle Name:PATRICIA
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16887 ROOSEVELT HWY
Mailing Address - Street 2:
Mailing Address - City:KENDALL
Mailing Address - State:NY
Mailing Address - Zip Code:14476-9748
Mailing Address - Country:US
Mailing Address - Phone:585-659-8958
Mailing Address - Fax:585-659-8988
Practice Address - Street 1:16887 ROOSEVELT HWY
Practice Address - Street 2:
Practice Address - City:KENDALL
Practice Address - State:NY
Practice Address - Zip Code:14476-9748
Practice Address - Country:US
Practice Address - Phone:585-659-8958
Practice Address - Fax:585-659-8988
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22681633163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool