Provider Demographics
NPI:1679696363
Name:MAZEIKA, LEANNE (NP)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:MAZEIKA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19 OLD HAMILTON EXT
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566
Mailing Address - Country:US
Mailing Address - Phone:508-363-9530
Mailing Address - Fax:508-363-9535
Practice Address - Street 1:123 SUMMER ST STE 690
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-363-9530
Practice Address - Fax:508-363-9535
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA191914363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics