Provider Demographics
NPI:1104543214
Name:MASTERS, NICHOLAS WILLIAM (RN)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:WILLIAM
Last Name:MASTERS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:NICHOLAS
Other - Middle Name:WILLIAM
Other - Last Name:MASTERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:2940 WYMAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2802
Mailing Address - Country:US
Mailing Address - Phone:717-586-7596
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301
Practice Address - Country:US
Practice Address - Phone:304-623-3461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR256079163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse