Provider Demographics
NPI:1053097022
Name:MASK, MARY CRYSTAL (CNA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CRYSTAL
Last Name:MASK
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CRYSTAL
Other - Last Name:MASK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNA
Mailing Address - Street 1:3815 UTICA PIKE JEFFERSONVILLE INDIANA
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE, IN
Mailing Address - State:IN
Mailing Address - Zip Code:47130
Mailing Address - Country:US
Mailing Address - Phone:150-238-1975
Mailing Address - Fax:
Practice Address - Street 1:3815 UTICA PIKE JEFFERSONVILLE INDIANA
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE, IN
Practice Address - State:IN
Practice Address - Zip Code:47130
Practice Address - Country:US
Practice Address - Phone:502-546-8797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care