Provider Demographics
NPI:1245115484
Name:MASON, ELYSIA D (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:ELYSIA
Middle Name:D
Last Name:MASON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 LONGVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-9738
Mailing Address - Country:US
Mailing Address - Phone:203-243-4539
Mailing Address - Fax:
Practice Address - Street 1:1629 LONGVIEW RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-9738
Practice Address - Country:US
Practice Address - Phone:203-243-4539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC210327163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant