Provider Demographics
NPI:1083411722
Name:MASON, EDNORA BRADLEY (RN)
Entity type:Individual
Prefix:
First Name:EDNORA
Middle Name:BRADLEY
Last Name:MASON
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 PEACH TREE CRES
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-7494
Mailing Address - Country:US
Mailing Address - Phone:757-342-5461
Mailing Address - Fax:
Practice Address - Street 1:6147 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-1511
Practice Address - Country:US
Practice Address - Phone:757-826-1300
Practice Address - Fax:804-482-3761
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001261344163W00000X, 163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163W00000XNursing Service ProvidersRegistered Nurse