Provider Demographics
NPI:1295422731
Name:MASON, MOIRA AGNES
Entity type:Individual
Prefix:
First Name:MOIRA
Middle Name:AGNES
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOIRA
Other - Middle Name:A
Other - Last Name:HAYDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:587 E BENRICH DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1625
Mailing Address - Country:US
Mailing Address - Phone:480-363-6161
Mailing Address - Fax:
Practice Address - Street 1:3370 S MERCY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0414
Practice Address - Country:US
Practice Address - Phone:602-933-3725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN082703163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse