Provider Demographics
NPI:1477799948
Name:RICH-MAZZEO, SONIA YVONNE
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:YVONNE
Last Name:RICH-MAZZEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:
Other - Last Name:RICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1321 N MCCARRAN BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-3873
Mailing Address - Country:US
Mailing Address - Phone:775-683-3833
Mailing Address - Fax:775-683-3831
Practice Address - Street 1:1321 N MCCARRAN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-3873
Practice Address - Country:US
Practice Address - Phone:775-683-3833
Practice Address - Fax:775-683-3831
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN89398163W00000X
NJ26NR13543400163W00000X
NJ26NJ00390200363LF0000X
NVAPRN002280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ246146IB7Medicare UPIN