=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780262915
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NOELIA MAS RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2021
-----------------------------------------------------
Last Update Date | 03/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 LAKE POINT LN
-----------------------------------------------------
City | BELEWS CREEK
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27009-9207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-686-5952
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1203 MAPLE ST
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27405-6910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-404-7427
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Registered Nurse
-----------------------------------------------------
License Number | 168091
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------