Provider Demographics
NPI:1477875045
Name:MAZUR, CORTNEY LYNN (RN, MSN, CPNP-AC)
Entity Type:Individual
Prefix:
First Name:CORTNEY
Middle Name:LYNN
Last Name:MAZUR
Suffix:
Gender:F
Credentials:RN, MSN, CPNP-AC
Other - Prefix:
Other - First Name:CORTNEY
Other - Middle Name:LYNN
Other - Last Name:OLESKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, CPNP-AC
Mailing Address - Street 1:16989 CARRIAGE WAY
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-6509
Mailing Address - Country:US
Mailing Address - Phone:586-703-3854
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-966-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704248909363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care