Provider Demographics
NPI:1811987795
Name:MASON, PEGGY SUE (CRNA)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:SUE
Last Name:MASON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4280 160TH ST
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-7598
Mailing Address - Country:US
Mailing Address - Phone:712-362-5217
Mailing Address - Fax:
Practice Address - Street 1:835 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4523
Practice Address - Country:US
Practice Address - Phone:507-238-8100
Practice Address - Fax:507-238-8642
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 133085-0174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist