Provider Demographics
NPI:1316418395
Name:MASON-DIPROSPERO, KEISHA MELODY (CRNP)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:MELODY
Last Name:MASON-DIPROSPERO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1330 POWELL ST STE 308
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-3350
Mailing Address - Country:US
Mailing Address - Phone:484-622-7395
Mailing Address - Fax:484-622-7399
Practice Address - Street 1:1437 DEKALB ST STE 201
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3440
Practice Address - Country:US
Practice Address - Phone:610-272-5341
Practice Address - Fax:610-277-4134
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP019447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily