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General NPI Number Information
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NPI Number | 1578009346
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Entity Type | Individual
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Provider Name | DEBRA JEAN MASSARO NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/17/2017
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 13199 CENTERPOINTE WAY
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City | WOODBRIDGE
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State | VA
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Zip | 22193-5284
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Country | US
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Telephone | 540-449-6077
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Fax |
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Provider Business Mailing Address
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Address Line | 17200 RIFFLE FORD RD
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City | GERMANTOWN
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State | MD
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Zip | 20874-2915
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Country | US
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Telephone | 154-044-9607
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024174335
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License Number State | VA
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