Provider Demographics
NPI:1235170879
Name:MASON, THERESA LOUISE (PHD, CRNP)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:LOUISE
Last Name:MASON
Suffix:
Gender:F
Credentials:PHD, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7660 REFUGEE RD SW
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-7764
Mailing Address - Country:US
Mailing Address - Phone:740-964-0615
Mailing Address - Fax:
Practice Address - Street 1:7660 REFUGEE RD SW
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-7764
Practice Address - Country:US
Practice Address - Phone:740-964-0615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP08733363LA2200X, 363LP0808X
PASP017393363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health