Provider Demographics
NPI:1740319516
Name:MASAK, CORNELIA B (RN, APNP)
Entity type:Individual
Prefix:MRS
First Name:CORNELIA
Middle Name:B
Last Name:MASAK
Suffix:
Gender:F
Credentials:RN, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1818 N MEADE ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-3454
Mailing Address - Country:US
Mailing Address - Phone:920-749-4000
Mailing Address - Fax:920-749-4015
Practice Address - Street 1:1818 N MEADE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3454
Practice Address - Country:US
Practice Address - Phone:920-749-4000
Practice Address - Fax:920-749-4015
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI93688363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner