Provider Demographics
NPI:1992526917
Name:MCCAULEY-MASSE, TAMMY JO (BSN RN CCM)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:JO
Last Name:MCCAULEY-MASSE
Suffix:
Gender:F
Credentials:BSN RN CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-5553
Mailing Address - Country:US
Mailing Address - Phone:207-451-3174
Mailing Address - Fax:
Practice Address - Street 1:402 GOODRICH AVE
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904
Practice Address - Country:US
Practice Address - Phone:207-438-2354
Practice Address - Fax:401-841-2118
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN178262163WC0400X
MERN44730163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management