Provider Demographics
NPI:1013644285
Name:MASON, KARAH LEANN
Entity Type:Individual
Prefix:
First Name:KARAH
Middle Name:LEANN
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 1:3584 JEFFERSON MARION RD SE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OR
Mailing Address - Zip Code:97352-9276
Mailing Address - Country:US
Mailing Address - Phone:503-509-8063
Mailing Address - Fax:
Practice Address - Street 1:8515 STAYTON RD SE
Practice Address - Street 2:
Practice Address - City:TURNER
Practice Address - State:OR
Practice Address - Zip Code:97392-9752
Practice Address - Country:US
Practice Address - Phone:503-509-8063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202005944LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR791480OtherSTATE PERSONAL SUPPORT WORKER
OR202005944LPNOtherSTATE BOARD OF NURSING