Provider Demographics
NPI:1356766505
Name:MASSAQUOI, EDWINA S (RN)
Entity type:Individual
Prefix:MISS
First Name:EDWINA
Middle Name:S
Last Name:MASSAQUOI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CASS ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08611-2405
Mailing Address - Country:US
Mailing Address - Phone:609-256-4200
Mailing Address - Fax:
Practice Address - Street 1:833 CASS ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08611-2405
Practice Address - Country:US
Practice Address - Phone:609-256-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO12476100163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse