Healthcare Provider Details

I. General information

NPI: 1548522139
Provider Name (Legal Business Name): VANESSA J. MASSE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 LYMAN ST STE 100A
WESTBOROUGH MA
01581-1431
US

IV. Provider business mailing address

51 WINTHROP ST APT 3
EVERETT MA
02149-2607
US

V. Phone/Fax

Practice location:
  • Phone: 508-614-9340
  • Fax: 508-785-7078
Mailing address:
  • Phone: 617-970-1204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0811379
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: