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General NPI Number Information
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NPI Number | 1497381941
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Entity Type | Individual
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Provider Name | MAZOUZAH OMAR DNP
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Gender | Female
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Dates
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Enumeration Date | 03/17/2020
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 1620 W HARRISON ST
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City | CHICAGO
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State | IL
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Zip | 60612-3801
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Country | US
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Telephone | 708-928-3421
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Fax |
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Provider Business Mailing Address
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Address Line | 8148 W 111TH ST APT B1
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City | PALOS HILLS
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State | IL
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Zip | 60465-3234
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Country | US
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Telephone | 708-928-3421
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 277003454
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 209021046
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License Number State | IL
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