Healthcare Provider Details

I. General information

NPI: 1477799948
Provider Name (Legal Business Name): SONIA YVONNE RICH-MAZZEO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SONIA RICH APRN

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 N MCCARRAN BLVD STE 104
SPARKS NV
89431-3873
US

IV. Provider business mailing address

1321 N MCCARRAN BLVD STE 104
SPARKS NV
89431-3873
US

V. Phone/Fax

Practice location:
  • Phone: 775-683-3833
  • Fax: 775-683-3831
Mailing address:
  • Phone: 775-683-3833
  • Fax: 775-683-3831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00390200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002280
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN89398
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR13543400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: