Healthcare Provider Details

I. General information

NPI: 1467811638
Provider Name (Legal Business Name): STEVEN FREDERICK MASON MSN, APN PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39465 W 14 MILE RD
NOVI MI
48377-1600
US

IV. Provider business mailing address

3 BYNUM DR
BATTLE CREEK MI
49017-1703
US

V. Phone/Fax

Practice location:
  • Phone: 877-906-9699
  • Fax: 888-483-0118
Mailing address:
  • Phone: 269-275-4528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704235099
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: