Provider Demographics
NPI:1043683238
Name:MASSIE, INGE MARION
Entity Type:Individual
Prefix:MS
First Name:INGE
Middle Name:MARION
Last Name:MASSIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 FINLEY DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-3756
Mailing Address - Country:US
Mailing Address - Phone:330-715-6614
Mailing Address - Fax:
Practice Address - Street 1:1861 FINLEY DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3756
Practice Address - Country:US
Practice Address - Phone:330-715-6614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401435050812374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide