Provider Demographics
NPI:1801012646
Name:CZAN, MARY A (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:CZAN
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 1:7311 ADELPHI RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-1902
Mailing Address - Country:US
Mailing Address - Phone:301-422-1166
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MARYLAND HEALTH CTR
Practice Address - Street 2:140 CAMPUS DRIVE
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20742-0001
Practice Address - Country:US
Practice Address - Phone:301-314-8157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR125206163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health