Individual
CHARLOTTE K MASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1110 MAPLE WAY, JACKSON, WY 83002
(307) 733-7003
Mailing address
PO BOX 10738, JACKSON, WY 83002
(307) 733-7003
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
17365.721
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
311661
BLUE CROSS BLUE SHIELD WY
WY
Enumeration date
10/20/2006
Last updated
07/08/2007
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