MEDICARE: HEATHER MASON CNP

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	363LA2100X	Acute Care Nurse Practitioner	COA.16794-NP	OH
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.16794	OH
3	363LA2100X	Acute Care Nurse Practitioner	RN.326367-COA1	OH

General Provider Information

NPI Number	:	1205234341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MASON CNP

Provider Business Mailing Address
First Line	:	7556 STATE ROUTE 45 STE B
Second Line	:
City	:	LISBON
State	:	OH
Zip	:	44432-9807
Country	:	US
Telephone Number	:	330-870-4127
Fax Number	:	330-870-4139

Provider Business Practice Location Address
First Line	:	7556 STATE ROUTE 45 STE B
Second Line	:
City	:	LISBON
State	:	OH
Zip	:	44432-9807
Country	:	US
Telephone Number	:	330-870-4127
Fax Number	:	330-870-4139

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

Provider Enumeration Date	:	12/05/2014
Last Update Date	:	09/19/2025

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Directions to “ HEATHER MASON CNP” Practice Location

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