Provider Demographics
NPI:1386989077
Name:MASON, ALICIA DANYCE (FNP-C)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:DANYCE
Last Name:MASON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 LAFRANIER RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-8972
Mailing Address - Country:US
Mailing Address - Phone:231-995-6111
Mailing Address - Fax:231-995-6100
Practice Address - Street 1:880 PARSONS RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3622
Practice Address - Country:US
Practice Address - Phone:231-922-6416
Practice Address - Fax:231-922-6472
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704291445363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner