Healthcare Provider Details

I. General information

NPI: 1477574499
Provider Name (Legal Business Name): MARY Y MASSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-4000
  • Fax:
Mailing address:
  • Phone: 504-842-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberRN046593-AP03532
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN046593
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP03532
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: