Provider Demographics
NPI:1982268546
Name:MASON, ILA R (FNP-C)
Entity type:Individual
Prefix:
First Name:ILA
Middle Name:R
Last Name:MASON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ILA
Other - Middle Name:R
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RENEE MASON FNP-C
Mailing Address - Street 1:2072 N COUNTY ROAD 700 W
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47634-9480
Mailing Address - Country:US
Mailing Address - Phone:812-359-4012
Mailing Address - Fax:812-359-4481
Practice Address - Street 1:2072 N COUNTY ROAD 700 W
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:IN
Practice Address - Zip Code:47634-9480
Practice Address - Country:US
Practice Address - Phone:812-359-4012
Practice Address - Fax:812-359-4481
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008933A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine