Basic Information
| Provider Information | |||||||||
| NPI: | 1134115645 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAZZA | ||||||||
| FirstName: | MARY | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4820 W TAFT RD | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | LIVERPOOL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130882800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154486215 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4820 W TAFT RD | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | LIVERPOOL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130882800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154486215 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 09/13/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F331446 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.