MEDICARE: MS. VICKI LIN MASON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	RN129013	AZ

General Provider Information

NPI Number	:	1043029317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICKI LIN MASON RN

Provider Business Mailing Address
First Line	:	8701 S KOLB RD # 7-285
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85756-9607
Country	:	US
Telephone Number	:	520-356-3655
Fax Number	:

Provider Business Practice Location Address
First Line	:	8701 S KOLB RD # 7-285
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85756-9607
Country	:	US
Telephone Number	:	520-356-3655
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2025
Last Update Date	:	01/02/2025

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