Provider Demographics
NPI:1225769326
Name:MAZUR, ANNA LEIGH
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:LEIGH
Last Name:MAZUR
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 1:4087 N ELLISTON TROWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GRAYTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43432-9751
Mailing Address - Country:US
Mailing Address - Phone:419-266-2129
Mailing Address - Fax:
Practice Address - Street 1:4087 N ELLISTON TROWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:GRAYTOWN
Practice Address - State:OH
Practice Address - Zip Code:43432-9751
Practice Address - Country:US
Practice Address - Phone:419-266-2129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant