Provider Demographics
NPI:1396551453
Name:STANDIFIRD, MASON ALDEN (FNP)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:ALDEN
Last Name:STANDIFIRD
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N MCLANE RD
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-3633
Mailing Address - Country:US
Mailing Address - Phone:928-978-2875
Mailing Address - Fax:
Practice Address - Street 1:127 E MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5646
Practice Address - Country:US
Practice Address - Phone:928-468-8603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ241718363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily