Individual
MASSA KEITA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6800 GUYER AVE, PHILADELPHIA, PA 19142-2519
(267) 580-3136
Mailing address
6800 GUYER AVE, PHILADELPHIA, PA 19142-2519
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN302295
PA
Other
Enumeration date
03/11/2020
Last updated
03/11/2020
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