Provider Demographics
NPI:1922062751
Name:KASSIRER, AMY JO (RNP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:JO
Last Name:KASSIRER
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:KASSIRER
Other - Last Name:HOCHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNP
Mailing Address - Street 1:21 HAROLD STREET
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703
Mailing Address - Country:US
Mailing Address - Phone:508-243-6571
Mailing Address - Fax:
Practice Address - Street 1:4 POST OFFICE SQ
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3207
Practice Address - Country:US
Practice Address - Phone:508-823-5291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2640363L00000X
MARN233244363L00000X
MA233244363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI23440-3OtherBCBS RI
MA110019543AMedicaid
MANP2640OtherBCBS MA
RI23440-3OtherBCBS RI