Provider Demographics
NPI:1164476537
Name:MAZZEI, JOSEPH L (CRNA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:MAZZEI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-0446
Mailing Address - Country:US
Mailing Address - Phone:207-251-4300
Mailing Address - Fax:207-251-4300
Practice Address - Street 1:125 DWIGHT DR
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090-5756
Practice Address - Country:US
Practice Address - Phone:207-251-4300
Practice Address - Fax:207-251-4300
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN92791/ARNP9836367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3633303Medicaid
TN4112595OtherBCBS TN
TN4112595OtherBCBS TN