Provider Demographics
NPI:1811051808
Name:MASON, JUDY (RN)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:HUTCHINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 510721
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84151-0721
Mailing Address - Country:US
Mailing Address - Phone:801-297-4891
Mailing Address - Fax:
Practice Address - Street 1:7495 S STATE ST
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2013
Practice Address - Country:US
Practice Address - Phone:801-213-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1863133102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse