Provider Demographics
NPI:1720836356
Name:MASON, STEFANIE PAIGE (RN)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:PAIGE
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 1:914 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-3313
Mailing Address - Country:US
Mailing Address - Phone:573-620-3471
Mailing Address - Fax:
Practice Address - Street 1:1102 OSAGE ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-2336
Practice Address - Country:US
Practice Address - Phone:573-620-3643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014021532163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse