Provider Demographics
NPI:1881232643
Name:MASON, JOAN L (APN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:L
Last Name:MASON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:L
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:9853 N COUNTY HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:TABLE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:61482-9437
Mailing Address - Country:US
Mailing Address - Phone:309-224-0662
Mailing Address - Fax:
Practice Address - Street 1:530 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637-0001
Practice Address - Country:US
Practice Address - Phone:309-655-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.020198363LX0106X
IL209020198363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health