Provider Demographics
NPI:1548267701
Name:MASON, RENAE (MS, RN, CS, FNP-C)
Entity type:Individual
Prefix:MS
First Name:RENAE
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:MS, RN, CS, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3143 MAGIC HOLLOW BLVD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-3077
Mailing Address - Country:US
Mailing Address - Phone:757-385-8222
Mailing Address - Fax:
Practice Address - Street 1:3143 MAGIC HOLLOW BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-3077
Practice Address - Country:US
Practice Address - Phone:757-385-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-02
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001057129163W00000X
WI140826030163W00000X
VA0024057129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA18615624725Medicaid