Provider Demographics
NPI:1619662707
Name:MAZIE, EMEKA J
Entity Type:Individual
Prefix:
First Name:EMEKA
Middle Name:J
Last Name:MAZIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4426 MARIGOLD TRL
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2332
Mailing Address - Country:US
Mailing Address - Phone:214-444-1777
Mailing Address - Fax:
Practice Address - Street 1:4426 MARIGOLD TRL
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2332
Practice Address - Country:US
Practice Address - Phone:214-444-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1061185363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health