Provider Demographics
NPI:1841224961
Name:MASTURZO, VICKIE MARIE (CLPN)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:MARIE
Last Name:MASTURZO
Suffix:
Gender:F
Credentials:CLPN
Other - Prefix:MRS
Other - First Name:VICKIE
Other - Middle Name:MARIE
Other - Last Name:CAMPRIANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CLPN
Mailing Address - Street 1:2761 REVERE DR
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1734
Mailing Address - Country:US
Mailing Address - Phone:330-928-3725
Mailing Address - Fax:
Practice Address - Street 1:2761 REVERE DR
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1734
Practice Address - Country:US
Practice Address - Phone:330-928-3725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-042566164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2134756Medicaid