MEDICARE: MAGGIE WHITT MAZUREK 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	363LF0000X	Family Nurse Practitioner	246723	NC
2	363LF0000X	Family Nurse Practitioner	95000436	CA
3	363LF0000X	Family Nurse Practitioner	24007	SC
4	363LF0000X	Family Nurse Practitioner	5007328	NC

General Provider Information

NPI Number	:	1376968487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGGIE WHITT MAZUREK FNP-C

Provider Business Mailing Address
First Line	:	2005 PISGAH CHURCH RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-3309
Country	:	US
Telephone Number	:	336-701-2662
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 PISGAH CHURCH RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-3309
Country	:	US
Telephone Number	:	336-701-2662
Fax Number	:

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

Provider Enumeration Date	:	02/26/2014
Last Update Date	:	05/04/2022

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