Provider Demographics
NPI:1700172350
Name:MASSARO, MARY CHRISTINE (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTINE
Last Name:MASSARO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CHRISTINE
Other - Last Name:MCNABNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:930 BLUE GENTIAN RD STE 1000
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1675
Mailing Address - Country:US
Mailing Address - Phone:651-683-2507
Mailing Address - Fax:651-340-1093
Practice Address - Street 1:930 BLUE GENTIAN RD STE 1000
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1675
Practice Address - Country:US
Practice Address - Phone:651-683-2507
Practice Address - Fax:651-340-1093
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 147243-3363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily