Provider Demographics
NPI:1720067465
Name:MAASSEL, VICTORIA S (PA-C)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:S
Last Name:MAASSEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:S
Other - Last Name:FRANDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1818 CAREW STREET
Mailing Address - Street 2:SUITE 260
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805
Mailing Address - Country:US
Mailing Address - Phone:260-373-9250
Mailing Address - Fax:260-373-9262
Practice Address - Street 1:1818 CAREW STREET
Practice Address - Street 2:SUITE 260
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805
Practice Address - Country:US
Practice Address - Phone:260-373-9250
Practice Address - Fax:260-373-9262
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000343A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN3937240010OtherMEDICARE DMEPOS
IN000000284682OtherANTHEM
IN000000284682OtherANTHEM
IN97001788Medicare PIN
IN070840HMedicare PIN
IN3937240010OtherMEDICARE DMEPOS
IN070830KMedicare PIN
IN070880IMedicare PIN
IN970017889Medicare PIN
IN070860CCMedicare PIN