MEDICARE: RUTH PRISCILLA MASTERSON RNCS

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	143918	MA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	143918	MA
3	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	143918	MA

General Provider Information

NPI Number	:	1801898846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH PRISCILLA MASTERSON RNCS

Provider Business Mailing Address
First Line	:	235 WOODLAND N
Second Line	:
City	:	LYNN
State	:	MA
Zip	:	01904-1414
Country	:	US
Telephone Number	:	978-675-9510
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 FRIEND ST
Second Line	:
City	:	LYNN
State	:	MA
Zip	:	01902
Country	:	US
Telephone Number	:	781-715-3816
Fax Number	:

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	01/28/2025

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