MEDICARE: MARY EVA OSTASZEWSKI FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN144234	GA
2	363LF0000X	Family Nurse Practitioner	RN 144234	GA

General Provider Information

NPI Number	:	1003013236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY EVA OSTASZEWSKI FNP-C

Provider Business Mailing Address
First Line	:	4720 NELSON BROGDON BLVD
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30518-3480
Country	:	US
Telephone Number	:	770-945-1990
Fax Number	:	770-945-3631

Provider Business Practice Location Address
First Line	:	4720 NELSON BROGDON BLVD
Second Line	:
City	:	SUGAR HILL
State	:	GA
Zip	:	30518-3480
Country	:	US
Telephone Number	:	770-945-1990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	01/09/2026

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