Provider Demographics
NPI:1336881721
Name:MASON-OWENS, KEYSHA
Entity Type:Individual
Prefix:
First Name:KEYSHA
Middle Name:
Last Name:MASON-OWENS
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 1:650 E 185TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1767
Mailing Address - Country:US
Mailing Address - Phone:216-675-0007
Mailing Address - Fax:
Practice Address - Street 1:650 E 185TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-1767
Practice Address - Country:US
Practice Address - Phone:216-675-0007
Practice Address - Fax:216-862-3100
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH377826151298376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide