Provider Demographics
NPI:1720758121
Name:MASSIE, BRITTANY N
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:N
Last Name:MASSIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:ZALESKI
Mailing Address - State:OH
Mailing Address - Zip Code:45698-0394
Mailing Address - Country:US
Mailing Address - Phone:740-988-6312
Mailing Address - Fax:
Practice Address - Street 1:16795 HAYDENVILLE RD
Practice Address - Street 2:
Practice Address - City:HAYDENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43127-7701
Practice Address - Country:US
Practice Address - Phone:740-988-6312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0435565Medicaid