Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 095006984 | OR |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 095006984N6 | OR |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 21885 | CA |
NPI | 1023114865 |
---|---|
Provider Name | Lori M Mason |
First Address | Paradise, CA 95969-5624 |
Second Address | Paradise, CA 95969-5624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 17/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
269762 | (05) | OR |
P26635 | (02) | OR |
P26635 | (05) | OR |