MEDICARE: KEYSHA MASON-OWENS

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	376K00000X	Nurse's Aide	377826151298	OH

General Provider Information

NPI Number	:	1336881721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYSHA MASON-OWENS

Provider Business Mailing Address
First Line	:	650 E 185TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-1767
Country	:	US
Telephone Number	:	216-675-0007
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 E 185TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-1767
Country	:	US
Telephone Number	:	216-675-0007
Fax Number	:	216-862-3100

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

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	04/07/2022

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Directions to “ KEYSHA MASON-OWENS ” Practice Location

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