Healthcare Provider Details

I. General information

NPI: 1497157572
Provider Name (Legal Business Name): GLORIA MARY MAZZA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2014
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HOWARD AVE BOX 8269
CRANSTON RI
02920-3001
US

IV. Provider business mailing address

35 S COUNTY COMMONS WAY STE D11
WAKEFIELD RI
02879-8252
US

V. Phone/Fax

Practice location:
  • Phone: 401-447-1777
  • Fax:
Mailing address:
  • Phone: 401-447-1777
  • Fax: 401-205-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNPP37899
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN02129
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: