Provider Demographics
NPI:1528890035
Name:MASON, ALTAGRACIA AERIAL
Entity type:Individual
Prefix:
First Name:ALTAGRACIA
Middle Name:AERIAL
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 1:555 LINCOLN AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5071
Mailing Address - Country:US
Mailing Address - Phone:616-401-4416
Mailing Address - Fax:
Practice Address - Street 1:555 LINCOLN AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-5071
Practice Address - Country:US
Practice Address - Phone:616-401-4416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula