Individual
MASON NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1417 ALTIS DR UNIT 207, OCONOMOWOC, WI 53066-1293
(218) 530-0035
Mailing address
1417 ALTIS DR UNIT 207, OCONOMOWOC, WI 53066-1293
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7511
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100253607
—
WI
Enumeration date
03/03/2023
Last updated
04/16/2026
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