Individual
MRS. ETHELRENEE MASSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
154 CHESTNUT ST, BRIDGEPORT, CT 06604-2640
(646) 396-9304
Mailing address
154 CHESTNUT ST, BRIDGEPORT, CT 06604-2640
(646) 396-9304
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
3032461
NY
Other
Enumeration date
03/02/2011
Last updated
03/02/2011
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