Provider Demographics
NPI:1285455899
Name:MASESE, ISABELLA (NP)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:MASESE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8638 MINERAL RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6148
Mailing Address - Country:US
Mailing Address - Phone:980-253-8296
Mailing Address - Fax:
Practice Address - Street 1:8638 MINERAL RIDGE WAY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-6148
Practice Address - Country:US
Practice Address - Phone:980-253-8296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021269363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty