Provider Demographics
NPI:1417403312
Name:MASIH, EDWIN (MSN, RN)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:MASIH
Suffix:
Gender:M
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 GREENWOOD SPRINGS BLVD
Mailing Address - Street 2:#201
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6479
Mailing Address - Country:US
Mailing Address - Phone:317-396-1300
Mailing Address - Fax:317-396-1415
Practice Address - Street 1:1051 GREENWOOD SPRINGS BLVD
Practice Address - Street 2:#201
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6479
Practice Address - Country:US
Practice Address - Phone:317-396-1300
Practice Address - Fax:317-396-1415
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006967A363L00000X
IN28156380A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse