Provider Demographics
NPI:1487060349
Name:MASSARO, GREGORY JAMES (LPN)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:JAMES
Last Name:MASSARO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 REBECCA ST
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-4268
Mailing Address - Country:US
Mailing Address - Phone:330-621-8507
Mailing Address - Fax:
Practice Address - Street 1:924 REBECCA ST
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-4268
Practice Address - Country:US
Practice Address - Phone:330-621-8507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN097438164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse