Provider Demographics
NPI:1386456333
Name:MASSET, EMILY ANNA ROSE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNA ROSE
Last Name:MASSET
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 1:104 2ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:MOFFIT
Mailing Address - State:ND
Mailing Address - Zip Code:58560-4014
Mailing Address - Country:US
Mailing Address - Phone:701-329-0859
Mailing Address - Fax:
Practice Address - Street 1:104 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:MOFFIT
Practice Address - State:ND
Practice Address - Zip Code:58560-4014
Practice Address - Country:US
Practice Address - Phone:701-329-0859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant