Provider Demographics
NPI:1003974585
Name:MAZANEC, MARY S (NP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:S
Last Name:MAZANEC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:S
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:75 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1795
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:781-878-3989
Practice Address - Street 1:75 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-9147
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:781-878-3989
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA263381363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042297845OtherGREAT WEST HEALTH CARE
MANP5514OtherMEDICARE
MA042297845OtherPHCS
042297845OtherMULTI-PLAN
MA0710661Medicaid
MA121285OtherFALLON
MA042297845OtherTRICARE
MANP9628OtherBCBSMA