Provider Demographics
NPI:1760158885
Name:MASSE, GABRIELLE MARI (FNP-C)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:MARI
Last Name:MASSE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 BRICKYARD FALLS RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9572
Mailing Address - Country:US
Mailing Address - Phone:315-552-4695
Mailing Address - Fax:
Practice Address - Street 1:4440 BRICKYARD FALLS RD
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9572
Practice Address - Country:US
Practice Address - Phone:315-552-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348181363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily