Provider Demographics
NPI:1245573203
Name:MASSARO, ANITA D
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:D
Last Name:MASSARO
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 1:2704 31ST ST SE
Mailing Address - Street 2:#631
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-1524
Mailing Address - Country:US
Mailing Address - Phone:202-758-9838
Mailing Address - Fax:
Practice Address - Street 1:2704 31ST ST SE
Practice Address - Street 2:#631
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1524
Practice Address - Country:US
Practice Address - Phone:202-758-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN960167163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse