Provider Demographics
NPI:1730993163
Name:MASON, KEELEY MARIE
Entity type:Individual
Prefix:
First Name:KEELEY
Middle Name:MARIE
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LANGDON
Mailing Address - State:ND
Mailing Address - Zip Code:58249-2606
Mailing Address - Country:US
Mailing Address - Phone:701-317-4383
Mailing Address - Fax:
Practice Address - Street 1:622 1ST ST
Practice Address - Street 2:
Practice Address - City:LANGDON
Practice Address - State:ND
Practice Address - Zip Code:58249-2606
Practice Address - Country:US
Practice Address - Phone:701-317-4383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion