Individual
DEANNA L. MASSIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNS
Contact information
Practice address
7910 W JEFFERSON BLVD STE 112, FORT WAYNE, IN 46804-4159
(260) 969-7121
(260) 407-4330
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3514
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
71003492A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0070146
—
OH
05
—
201031980
—
IN
01
—
P01102663
RAILROAD MEDICARE
IN
Enumeration date
09/01/2011
Last updated
09/29/2020
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