Individual
TYREASEA ANICHA JOHNSON-MASON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
215 HIGHLAND AVE STE 100, HADDON TOWNSHIP, NJ 08108-2634
(609) 350-4792
(856) 823-1922
Mailing address
215 HIGHLAND AVE STE 100, HADDON TOWNSHIP, NJ 08108-2634
(609) 350-4792
(856) 823-1922
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
26NJ00429100
NJ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
SP012833
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0379077
—
NJ
01
—
1003250101
NPI
NJ
Enumeration date
04/19/2013
Last updated
04/15/2020
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