Basic Information
| Provider Information | |||||||||
| NPI: | 1417403312 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASIH | ||||||||
| FirstName: | EDWIN | ||||||||
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| Credential: | MSN, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1051 GREENWOOD SPRINGS BLVD | ||||||||
| Address2: | #201 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461436479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173961300 | ||||||||
| FaxNumber: | 3173961415 | ||||||||
| Practice Location | |||||||||
| Address1: | 1051 GREENWOOD SPRINGS BLVD | ||||||||
| Address2: | #201 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461436479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173961300 | ||||||||
| FaxNumber: | 3173961415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2016 | ||||||||
| LastUpdateDate: | 03/21/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 71006967A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163W00000X | 28156380A | IN | N | Nursing Service Providers | Registered Nurse |
No ID Information.