Provider Demographics
NPI:1134383797
Name:MASON, ELIZABETH BROWN (RN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BROWN
Last Name:MASON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 RIDGELAND DR
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-6806
Mailing Address - Country:US
Mailing Address - Phone:270-705-3789
Mailing Address - Fax:
Practice Address - Street 1:151 RIDGELAND DR
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-6806
Practice Address - Country:US
Practice Address - Phone:270-705-3789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1082200171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator