Provider Demographics
NPI:1063771772
Name:MASON, RACHEL BETH (LPN)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:BETH
Last Name:MASON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18708 MINKLER RD
Mailing Address - Street 2:
Mailing Address - City:ADAMS CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13606-3134
Mailing Address - Country:US
Mailing Address - Phone:561-818-2361
Mailing Address - Fax:
Practice Address - Street 1:33407 COUNTY ROUTE 46
Practice Address - Street 2:
Practice Address - City:THERESA
Practice Address - State:NY
Practice Address - Zip Code:13691-2067
Practice Address - Country:US
Practice Address - Phone:315-955-5935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307458164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse