Healthcare Provider Details

I. General information

NPI: 1801027768
Provider Name (Legal Business Name): ANNETTE J MAZZAARELLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 GIBBS RD
ORCAS WA
98280
US

IV. Provider business mailing address

PO BOX 383
ORCAS WA
98280-0383
US

V. Phone/Fax

Practice location:
  • Phone: 360-376-8874
  • Fax:
Mailing address:
  • Phone: 360-376-8874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD00016926
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: