Provider Demographics
NPI:1437172079
Name:MASSEY, SUSAN E (CNM, WHNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:MASSEY
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-5951
Mailing Address - Country:US
Mailing Address - Phone:618-997-5266
Mailing Address - Fax:833-431-2272
Practice Address - Street 1:3130 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-5951
Practice Address - Country:US
Practice Address - Phone:618-997-5266
Practice Address - Fax:833-431-2272
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO131902363LW0102X, 367A00000X
IL209-000556363LX0001X
IL209-000554367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology