Provider Demographics
NPI:1114308244
Name:MAZURKIVICH, BARBARA
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:
Last Name:MAZURKIVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18643-2136
Mailing Address - Country:US
Mailing Address - Phone:570-861-9045
Mailing Address - Fax:570-602-4100
Practice Address - Street 1:1262 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:PA
Practice Address - Zip Code:18643-1454
Practice Address - Country:US
Practice Address - Phone:570-861-9045
Practice Address - Fax:570-602-4100
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker