Provider Demographics
NPI:1548522139
Name:MASSE, VANESSA J (NP-C)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:J
Last Name:MASSE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 WINTHROP ST APT 3
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-2607
Mailing Address - Country:US
Mailing Address - Phone:617-970-1204
Mailing Address - Fax:
Practice Address - Street 1:18 LYMAN ST STE 100A
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1431
Practice Address - Country:US
Practice Address - Phone:508-614-9340
Practice Address - Fax:508-785-7078
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAF0811379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily