Provider Demographics
NPI:1891188405
Name:MASON, KIRSTIE
Entity Type:Individual
Prefix:
First Name:KIRSTIE
Middle Name:
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 1:947 BELSAGE CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-3701
Mailing Address - Country:US
Mailing Address - Phone:513-254-6208
Mailing Address - Fax:
Practice Address - Street 1:947 BELSAGE CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3701
Practice Address - Country:US
Practice Address - Phone:513-254-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-07
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148184164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse