Provider Demographics
NPI:1861639502
Name:MASS, PAULA JEAN (PA)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:MASS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2815 S PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3495
Mailing Address - Country:US
Mailing Address - Phone:517-975-9830
Mailing Address - Fax:
Practice Address - Street 1:2815 S PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3495
Practice Address - Country:US
Practice Address - Phone:517-975-9830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2014-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601002093363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical