Active NPI
Marie C Massillon
- Licensed Practical Nurse
- Cambridge, MA
National Provider Identifier
1801359708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- LN97158
- Practice address
- 1493 Cambridge St
Cambridge, MA 02139-1047 - Phone
- (617) 575-5850
- NPI assigned
- Apr 9, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | LN97158 | MA | Primary |
Addresses
Primary practice location
1493 Cambridge St
Cambridge, MA 02139-1047
Mailing address
160 Gore Street
Cambridge, MA 02139
Phone (617) 575-5850
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LN97158 | MA | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554768000000",
"number": "1801359708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 GORE STREET",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "02139",
"telephone_number": "617-575-5850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1493 CAMBRIDGE ST",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021391047",
"telephone_number": "617-575-5850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASSILLON",
"first_name": "MARIE",
"middle_name": "C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-04-09",
"last_updated": "2019-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Licensed Practical Nurse",
"state": "MA",
"license": "LN97158",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MA
- Massachusetts Institute of Technology
- Massachusetts Institute of Technology
- Massachusetts Institute of Technology
- Massachusetts Institute of Technology
- Massachusetts Institute of Technology
- Doryam Cecilia Massimo, MA
- Robert J. Master, MD
- Steven I Master, M.D.
- Bronwyn Mastrangelo, RN
- Bronwyn Kate Mastrangelo
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.