Healthcare Provider Details

I. General information

NPI: 1285001404
Provider Name (Legal Business Name): MARCY JEAN MASON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 619-26
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

115 SUMMIT DR
ROCHESTER NY
14620-3129
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-1218
  • Fax:
Mailing address:
  • Phone: 315-576-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number307293
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: