Healthcare Provider Details

I. General information

NPI: 1619347739
Provider Name (Legal Business Name): MARY WEST MARZOLF FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 SPRINGDALE DR
CLINTON SC
29325-7226
US

IV. Provider business mailing address

PO BOX 470408
CHARLOTTE NC
28247-0408
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-6287
  • Fax:
Mailing address:
  • Phone: 704-375-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19771
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: