Provider Demographics
NPI:1891459913
Name:MASSAR, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MASSAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 BONDS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-7529
Mailing Address - Country:US
Mailing Address - Phone:843-740-7441
Mailing Address - Fax:854-800-4057
Practice Address - Street 1:2670 BONDS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7529
Practice Address - Country:US
Practice Address - Phone:843-740-7441
Practice Address - Fax:854-800-4057
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC91783163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool