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General NPI Number Information
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NPI Number | 1437172079
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Entity Type | Individual
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Provider Name | SUSAN E MASSEY CNM, WHNP
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Gender | Female
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 3130 VETERANS MEMORIAL DR
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City | MOUNT VERNON
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State | IL
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Zip | 62864-5951
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Country | US
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Telephone | 618-997-5266
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Fax | 833-431-2272
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Provider Business Mailing Address
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Address Line | 3130 VETERANS MEMORIAL DR
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City | MOUNT VERNON
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State | IL
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Zip | 62864-5951
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Country | US
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Telephone | 618-997-5266
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Fax | 833-431-2272
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 131902
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | 209-000556
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 131902
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 209-000554
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License Number State | IL
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