MEDICARE: MS. RENAE MASON MS, RN, CS, FNP-C

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	0001057129	VA
2	163W00000X	Registered Nurse	140826030	WI
3	363LF0000X	Family Nurse Practitioner	0024057129	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548267701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RENAE MASON MS, RN, CS, FNP-C

Provider Business Mailing Address
First Line	:	3143 MAGIC HOLLOW BLVD
Second Line	:	SUITE 126
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-3077
Country	:	US
Telephone Number	:	757-385-8222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3143 MAGIC HOLLOW BLVD
Second Line	:	SUITE 200
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-3077
Country	:	US
Telephone Number	:	757-385-8222
Fax Number	:

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

Provider Enumeration Date	:	07/02/2005
Last Update Date	:	01/06/2016

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