Provider Demographics
NPI:1639392442
Name:MAURIZI, MARY (AWP C APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:MAURIZI
Suffix:
Gender:F
Credentials:AWP C APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26086 PEACH LN
Mailing Address - Street 2:P O BOX 531
Mailing Address - City:MEADVIEW
Mailing Address - State:AZ
Mailing Address - Zip Code:86444
Mailing Address - Country:US
Mailing Address - Phone:928-715-6991
Mailing Address - Fax:928-564-2661
Practice Address - Street 1:330 E MEADVIEW BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:MEADVIEW
Practice Address - State:AZ
Practice Address - Zip Code:86444
Practice Address - Country:US
Practice Address - Phone:928-715-6991
Practice Address - Fax:928-564-2661
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ2361363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ256145Medicaid