Healthcare Provider Details

I. General information

NPI: 1710232202
Provider Name (Legal Business Name): MARY M ZAMORSKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 BIRNIE AVE
SPRINGFIELD MA
01107-1108
US

IV. Provider business mailing address

354 BIRNIE AVE.
SPRINGFIELD MA
01107-1109
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-3470
  • Fax: 413-733-5235
Mailing address:
  • Phone: 413-733-3470
  • Fax: 413-733-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number131442
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: