Provider Demographics
NPI:1184675399
Name:PAUZAUSKIE, MARY E (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:PAUZAUSKIE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:OZAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNS
Mailing Address - Street 1:1102 W MACARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1743
Mailing Address - Country:US
Mailing Address - Phone:405-273-2270
Mailing Address - Fax:405-878-7129
Practice Address - Street 1:3208 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-5014
Practice Address - Country:US
Practice Address - Phone:405-878-7160
Practice Address - Fax:405-878-7149
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0061320364S00000X
OK61320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200049550BMedicaid
OK200049550AMedicaid
OK248510202Medicare PIN
OK248510203Medicare PIN
OK200049550BMedicaid
OK200049550AMedicaid
OK24H618617Medicare PIN