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General NPI Number Information
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NPI Number | 1740705391
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Entity Type | Individual
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Provider Name | EMILY K MASTERSON EMT-B
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Gender | Female
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Dates
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Enumeration Date | 08/04/2017
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Last Update Date | 08/11/2017
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Provider Practice Location Address
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Address Line | 241 WRIGHT ST
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City | MARQUETTE
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State | MI
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Zip | 49855-1955
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Country | US
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Telephone | 906-228-7611
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Fax |
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Provider Business Mailing Address
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Address Line | 405 E PARK ST APT 36
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City | MARQUETTE
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State | MI
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Zip | 49855-3646
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Country | US
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Telephone |
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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 | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number | 2000271
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | MI
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