Provider Demographics
NPI:1760739668
Name:MASSA, AMY ELIZABETH (RN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELIZABETH
Last Name:MASSA
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:STRODER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:HC 1 BOX 77A
Mailing Address - Street 2:
Mailing Address - City:LEOPOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63760-9714
Mailing Address - Country:US
Mailing Address - Phone:573-238-2542
Mailing Address - Fax:
Practice Address - Street 1:545 BROADRIDGE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-3001
Practice Address - Country:US
Practice Address - Phone:573-243-8408
Practice Address - Fax:573-243-0445
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004018094163W00000X
MO2012025816363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse