Provider Demographics
NPI:1134670136
Name:MAZURS, OLESSYA V (NP-C)
Entity Type:Individual
Prefix:
First Name:OLESSYA
Middle Name:V
Last Name:MAZURS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:OLESSYA
Other - Middle Name:V
Other - Last Name:BOLOTOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1375 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1350
Mailing Address - Country:US
Mailing Address - Phone:810-667-5639
Mailing Address - Fax:810-667-5604
Practice Address - Street 1:1375 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1350
Practice Address - Country:US
Practice Address - Phone:810-667-5639
Practice Address - Fax:810-667-5604
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704284965363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology