Provider Demographics
NPI:1609231190
Name:MAZUR, CAROL A (RN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:MAZUR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E LACROSSE ST
Mailing Address - Street 2:JUNEAU COUNTY HUMAN SERVICES
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-2101
Mailing Address - Country:US
Mailing Address - Phone:608-847-2400
Mailing Address - Fax:608-847-9599
Practice Address - Street 1:220 E LACROSSE ST
Practice Address - Street 2:JUNEAU COUNTY HUMAN SERVICES
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-2101
Practice Address - Country:US
Practice Address - Phone:608-847-2400
Practice Address - Fax:608-847-9599
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI133406163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse