Provider Demographics
NPI:1679240717
Name:AZURE, MASEN
Entity Type:Individual
Prefix:
First Name:MASEN
Middle Name:
Last Name:AZURE
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 1:812 4TH AVE S APT 102
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4560
Mailing Address - Country:US
Mailing Address - Phone:701-353-5088
Mailing Address - Fax:
Practice Address - Street 1:1923 12TH AVE N APT 2
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-2302
Practice Address - Country:US
Practice Address - Phone:701-340-6441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant