Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 2017013416 | MO |
NPI | 1205272341 |
---|---|
Provider Name | Dr. Katherine Mae Massa |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63108-1495 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2013 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200029660 | (05) | MO |