Healthcare Provider Details

I. General information

NPI: 1821056698
Provider Name (Legal Business Name): LAURA MASON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 05/11/2025
Certification Date: 05/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 WHITEHAVEN RD
GRAND ISLAND NY
14072-1846
US

IV. Provider business mailing address

22 TRAILS END
GRAND ISLAND NY
14072-2189
US

V. Phone/Fax

Practice location:
  • Phone: 716-453-1423
  • Fax:
Mailing address:
  • Phone: 716-887-5200
  • Fax: 716-625-1236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number303938
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: