Provider Demographics
NPI:1851034623
Name:MAZUREK, KATRINNA MAE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATRINNA
Middle Name:MAE
Last Name:MAZUREK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4641 E PICKARD ST STE A
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2189
Mailing Address - Country:US
Mailing Address - Phone:989-948-4863
Mailing Address - Fax:989-215-6501
Practice Address - Street 1:4641 E PICKARD ST STE A
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2189
Practice Address - Country:US
Practice Address - Phone:989-948-4863
Practice Address - Fax:989-215-6501
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704250289363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner