Provider Demographics
NPI:1902042831
Name:VARIAN-MAUZY, ASHLEY E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:E
Last Name:VARIAN-MAUZY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26280-0247
Mailing Address - Country:US
Mailing Address - Phone:304-335-2050
Mailing Address - Fax:
Practice Address - Street 1:46 TOWN CENTER PLZ STE A
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WV
Practice Address - Zip Code:26280-9752
Practice Address - Country:US
Practice Address - Phone:304-335-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-24
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01387363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPA33162Medicare PIN
WVPA33163Medicare PIN
WVPA33161Medicare PIN