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General NPI Number Information
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NPI Number | 1649873191
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Entity Type | Individual
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Provider Name | JOHN A MAZE REGISTERED NURSE
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Gender | Male
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 25201 E. 78 HWY BUILDING #5 MEDICAL
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City | INDEPENDENCE
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State | MO
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Zip | 64056
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Country | US
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Telephone | 816-695-4541
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Fax |
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Provider Business Mailing Address
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Address Line | 507 STACEY DR
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City | BELTON
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State | MO
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Zip | 64012-1832
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Country | US
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Telephone | 816-352-6190
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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 | 163WX0106X
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Taxonomy Name | Occupational Health Registered Nurse
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License Number | 133500
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License Number State | MO
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