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General NPI Number Information
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NPI Number | 1568832236
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Entity Type | Individual
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Provider Name | ELIZABETH JEAN MAZZELLA AGNP
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Gender | Female
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Dates
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Enumeration Date | 10/06/2015
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 5059 OLD 27 S
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City | GAYLORD
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State | MI
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Zip | 49735-9590
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Country | US
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Telephone | 989-705-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 912 N SUMMITVIEW DR
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City | GAYLORD
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State | MI
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Zip | 49735-9102
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Country | US
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Telephone | 989-858-0938
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704244043
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License Number State | MI
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