Provider Demographics
NPI:1770805277
Name:MASONBRINK, THERESA (APRN, CNS)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:MASONBRINK
Suffix:
Gender:F
Credentials:APRN, CNS
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:MARKOVICH, LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2285 BENDEN DR
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2568
Mailing Address - Country:US
Mailing Address - Phone:302-649-0293
Mailing Address - Fax:
Practice Address - Street 1:2285 BENDEN DR
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2568
Practice Address - Country:US
Practice Address - Phone:302-649-0293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704276138363LP0808X
VA0024185167363LP0808X
VT101.0136168TELE363LP0808X
CA5031364SP0809X
OHRN.280151363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult