Provider Demographics
NPI:1306232459
Name:IEZZI, MARI JORDON (APN)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:JORDON
Last Name:IEZZI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MARI
Other - Middle Name:JORDON
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3216 CHEVAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125
Mailing Address - Country:US
Mailing Address - Phone:870-636-3189
Mailing Address - Fax:
Practice Address - Street 1:2115 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-4233
Practice Address - Country:US
Practice Address - Phone:901-274-4085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004375363L00000X
TN20514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner