Provider Demographics
NPI:1700172350
Name:MASSARO, MARY CHRISTINE (FNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTINE
Last Name:MASSARO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CHRISTINE
Other - Last Name:MCNABNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1161 WAYZATA BLVD E # 162
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1935
Mailing Address - Country:US
Mailing Address - Phone:763-373-3856
Mailing Address - Fax:763-363-0333
Practice Address - Street 1:1161 WAYZATA BLVD E # 162
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1935
Practice Address - Country:US
Practice Address - Phone:763-373-3856
Practice Address - Fax:763-363-0333
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 147243-3363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily