Healthcare Provider Details

I. General information

NPI: 1306987508
Provider Name (Legal Business Name): NANCY ANN MAZUR N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 SIERRA DE RONDA
PALM SPRINGS CA
92264-9524
US

IV. Provider business mailing address

PO BOX 4335 1448 SIERRA DE RONDA
PALM SPRINGS CA
92263-4335
US

V. Phone/Fax

Practice location:
  • Phone: 860-614-6829
  • Fax:
Mailing address:
  • Phone: 860-614-6829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND-223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: