Healthcare Provider Details

I. General information

NPI: 1003974585
Provider Name (Legal Business Name): MARY S MAZANEC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY S SULLIVAN NP

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 WASHINGTON STREET
NORWELL MA
02061-9147
US

IV. Provider business mailing address

75 WASHINGTON ST
NORWELL MA
02061-1795
US

V. Phone/Fax

Practice location:
  • Phone: 781-878-5200
  • Fax: 781-878-3989
Mailing address:
  • Phone: 781-878-5200
  • Fax: 781-878-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number263381
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: