Provider Demographics
NPI:1891344941
Name:MASSAQUOI, MAIMA (LPN)
Entity Type:Individual
Prefix:
First Name:MAIMA
Middle Name:
Last Name:MASSAQUOI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 KERMIT DR STE 204
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-5102
Mailing Address - Country:US
Mailing Address - Phone:615-365-4424
Mailing Address - Fax:
Practice Address - Street 1:1101 KERMIT DR STE 204
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-5102
Practice Address - Country:US
Practice Address - Phone:615-365-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN88428251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN88428OtherNURSING LICENSE