Provider Demographics
NPI:1265424527
Name:MASHNI, JOSEPH (FNP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MASHNI
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 MEDICAL PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:MI
Mailing Address - Zip Code:49098-9225
Mailing Address - Country:US
Mailing Address - Phone:269-463-3600
Mailing Address - Fax:269-463-8206
Practice Address - Street 1:460 MEDICAL PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:MI
Practice Address - Zip Code:49098-9225
Practice Address - Country:US
Practice Address - Phone:269-463-3600
Practice Address - Fax:269-463-8206
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI47-04-141572363L00000X
MI4704141572363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104208690Medicaid
MI104208705Medicaid
MI140294150Medicaid
MI104208723Medicaid
MI104208714Medicaid