Provider Demographics
NPI:1023114865
Name:MASON, LORI M (PMHNP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:M
Last Name:MASON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 SKYWAY
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5624
Mailing Address - Country:US
Mailing Address - Phone:530-876-2000
Mailing Address - Fax:530-876-2586
Practice Address - Street 1:5125 SKYWAY
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5624
Practice Address - Country:US
Practice Address - Phone:530-876-2000
Practice Address - Fax:530-876-2586
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR095006984N6363LP0808X
OR095006984363LP0808X
CA21885363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269762Medicaid
ORP26635Medicaid
ORR131559Medicare PIN
ORP26635Medicaid
P26635Medicare PIN
ORP26635Medicare UPIN