Healthcare Provider Details

I. General information

NPI: 1205763919
Provider Name (Legal Business Name): MASON HIEDEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 BISHOPSGATE TER
HENDERSON NV
89074-6109
US

IV. Provider business mailing address

8 BISHOPSGATE TER
HENDERSON NV
89074-6109
US

V. Phone/Fax

Practice location:
  • Phone: 702-468-4085
  • Fax:
Mailing address:
  • Phone: 702-468-4085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number821427
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: