Provider Demographics
NPI:1801340807
Name:MASSAK, CHRISTA F (CRNP)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:F
Last Name:MASSAK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:
Other - Last Name:FANELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-2333
Practice Address - Country:US
Practice Address - Phone:570-271-6328
Practice Address - Fax:570-271-6955
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00660100363LA2200X, 363LG0600X, 363LP2300X
PASP016770363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care