Provider Demographics
NPI:1518302363
Name:MAZZELLA, HEIDI A (CNP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:A
Last Name:MAZZELLA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6559 WILSON MILLS RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-6402
Mailing Address - Country:US
Mailing Address - Phone:440-449-1540
Mailing Address - Fax:440-460-2833
Practice Address - Street 1:6559 WILSON MILLS RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-6402
Practice Address - Country:US
Practice Address - Phone:440-449-1540
Practice Address - Fax:440-460-2833
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHCOA14908NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health