Basic Information
Provider Information
NPI: 1578663159
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MASSOGLIA
FirstName: JANET
MiddleName: L
NamePrefix: MRS.
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1703 DURAND ST
Address2:  
City: SAGINAW
State: MI
PostalCode: 486025137
CountryCode: US
TelephoneNumber: 9894972500
FaxNumber:  
Practice Location
Address1: 1500 WEISS ST
Address2:  
City: SAGINAW
State: MI
PostalCode: 486025251
CountryCode: US
TelephoneNumber: 9894972500
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/24/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X4704182358MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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