Provider Demographics
NPI:1568459964
Name:MASTERSON, MARY MICHELLE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MICHELLE
Last Name:MASTERSON
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:7147 VISTA DR STE 150
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-9313
Mailing Address - Country:US
Mailing Address - Phone:515-875-9925
Mailing Address - Fax:515-875-9923
Practice Address - Street 1:5950 UNIVERSITY AVE
Practice Address - Street 2:STE 151
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266
Practice Address - Country:US
Practice Address - Phone:515-875-9192
Practice Address - Fax:515-875-9193
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2021-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IAA-099553363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP82677Medicare UPIN