MEDICARE: MS. NANCY MARIE MASON N.P.

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	363LP0200X	Pediatric Nurse Practitioner	4704149798	MI
2	363LS0200X	School Nurse Practitioner	4704149798	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0865710	OTHER	MI	BCBS PIN
3	4704149798	OTHER	MI	LICENSE

General Provider Information

NPI Number	:	1639124670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY MARIE MASON N.P.

Provider Business Mailing Address
First Line	:	43800 GARFIELD RD
Second Line	:	SUITE 201
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-1136
Country	:	US
Telephone Number	:	586-228-4652
Fax Number	:	586-228-4520

Provider Business Practice Location Address
First Line	:	2200 WOODWARD HTS
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-3007
Country	:	US
Telephone Number	:	248-543-4138
Fax Number	:	248-543-4252

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	09/11/2025

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