Provider Demographics
NPI:1073681904
Name:MASSAC, PHYLLIS A (RN)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:A
Last Name:MASSAC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8980
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-1980
Mailing Address - Country:US
Mailing Address - Phone:340-776-5017
Mailing Address - Fax:340-693-2697
Practice Address - Street 1:15 B PRINDSENS GADE
Practice Address - Street 2:
Practice Address - City:ST.THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00801-1980
Practice Address - Country:US
Practice Address - Phone:340-774-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1464163WH0200X, 163WH1000X, 163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Not Answered163WH1000XNursing Service ProvidersRegistered NurseHospice
Not Answered163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy