Healthcare Provider Details

I. General information

NPI: 1285455899
Provider Name (Legal Business Name): ISABELLA MASESE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8638 MINERAL RIDGE WAY
CHARLOTTE NC
28269-6148
US

IV. Provider business mailing address

8638 MINERAL RIDGE WAY
CHARLOTTE NC
28269-6148
US

V. Phone/Fax

Practice location:
  • Phone: 980-253-8296
  • Fax:
Mailing address:
  • Phone: 980-253-8296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5021269
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5021269
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: