Provider Demographics
NPI:1669614368
Name:MASSON, MARY CLAIRE (NP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CLAIRE
Last Name:MASSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 259 ONE WINOOSKI PARK
Mailing Address - Street 2:ST. MICHAEL'S COLLEGE STUDENT HEALTH SERVICES
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05439
Mailing Address - Country:US
Mailing Address - Phone:802-654-2234
Mailing Address - Fax:802-654-2699
Practice Address - Street 1:ONE WINOOSKI PARK
Practice Address - Street 2:ST. MICHAEL'S COLLEGE STUDENT HEALTH SERVICES
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05439
Practice Address - Country:US
Practice Address - Phone:802-654-2234
Practice Address - Fax:802-654-2699
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0020076363LP2300X, 363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT038034Medicare UPIN