MEDICARE: MS. JARISMA MASON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN.376043	OH

General Provider Information

NPI Number	:	1023492188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JARISMA MASON RN

Provider Business Mailing Address
First Line	:	4141 E 110TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-5324
Country	:	US
Telephone Number	:	216-254-3884
Fax Number	:

Provider Business Practice Location Address
First Line	:	4141 E 110TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-5324
Country	:	US
Telephone Number	:	216-254-3884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2015
Last Update Date	:	07/17/2015

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