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General NPI Number Information
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NPI Number | 1033879440
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Entity Type | Individual
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Provider Name | JESSICA ROSE MAZZI
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Gender | Female
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Dates
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Enumeration Date | 12/27/2021
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 1 GENESYS PKWY
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City | GRAND BLANC
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State | MI
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Zip | 48439-8065
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Country | US
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Telephone | 810-606-7392
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Fax |
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Provider Business Mailing Address
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Address Line | 200 MULLINS DR
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City | LEBANON
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State | OR
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Zip | 97355-3983
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Country | US
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Telephone | 541-259-0235
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 5151016649
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License Number State | MI
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