Provider Demographics
NPI:1841414497
Name:MASON, SHARLENE R (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHARLENE
Middle Name:R
Last Name:MASON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KELLARS LN APT A1
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-6248
Mailing Address - Country:US
Mailing Address - Phone:314-214-3247
Mailing Address - Fax:
Practice Address - Street 1:100 KELLARS LN
Practice Address - Street 2:A-1
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-6243
Practice Address - Country:US
Practice Address - Phone:314-214-3247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205108171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor