Healthcare Provider Details

I. General information

NPI: 1801898846
Provider Name (Legal Business Name): RUTH PRISCILLA MASTERSON RNCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 FRIEND ST
LYNN MA
01902
US

IV. Provider business mailing address

235 WOODLAND N
LYNN MA
01904-1414
US

V. Phone/Fax

Practice location:
  • Phone: 781-715-3816
  • Fax:
Mailing address:
  • Phone: 978-675-9510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number143918
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number143918
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number143918
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: