Provider Demographics
NPI:1427945492
Name:MASSIE, NATHANIA
Entity type:Individual
Prefix:
First Name:NATHANIA
Middle Name:
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 1:18820 W NORWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53146-1421
Mailing Address - Country:US
Mailing Address - Phone:262-302-0471
Mailing Address - Fax:
Practice Address - Street 1:N86W12999 NIGHTINGALE WAY
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2102
Practice Address - Country:US
Practice Address - Phone:414-777-1206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-21
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI150972-30163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator