Individual
MOLLY MASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(629) 485-6002
Mailing address
10400 75TH ST, KENOSHA, WI 53142-7884
(629) 485-6002
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
11725
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
652566-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100200133
—
WI
Enumeration date
01/24/2012
Last updated
07/11/2022
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