MEDICARE: MRS. MONICA MAZZELL RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	60862	SC

General Provider Information

NPI Number	:	1730524943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MONICA MAZZELL RN

Provider Business Mailing Address
First Line	:	1830 CHUKKER CREEK RD
Second Line	:
City	:	AIKEN
State	:	SC
Zip	:	29803-6828
Country	:	US
Telephone Number	:	803-641-2474
Fax Number	:	803-641-2537

Provider Business Practice Location Address
First Line	:	1830 CHUKKER CREEK RD
Second Line	:
City	:	AIKEN
State	:	SC
Zip	:	29803-6828
Country	:	US
Telephone Number	:	803-641-2474
Fax Number	:	803-641-2537

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2013
Last Update Date	:	05/01/2013

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