Provider Demographics
NPI:1528570728
Name:MAZZA, ANDREA M (MSN, RN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:MAZZA
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:MAZZA-HELMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN
Mailing Address - Street 1:605 PALMER ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:NY
Mailing Address - Zip Code:13340-1428
Mailing Address - Country:US
Mailing Address - Phone:315-894-1768
Mailing Address - Fax:
Practice Address - Street 1:605 PALMER ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:NY
Practice Address - Zip Code:13340-1428
Practice Address - Country:US
Practice Address - Phone:315-895-7781
Practice Address - Fax:315-895-4032
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY526790163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool