Provider Demographics
NPI:1013110576
Name:KAZANOWSKI, MARY KATHRYN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHRYN
Last Name:KAZANOWSKI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:KATHRYN
Other - Last Name:KAZANOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:11 WEYMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5025
Mailing Address - Country:US
Mailing Address - Phone:603-472-2550
Mailing Address - Fax:603-472-3933
Practice Address - Street 1:125 LANGFORD RD
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:NH
Practice Address - Zip Code:03077-1710
Practice Address - Country:US
Practice Address - Phone:603-895-9303
Practice Address - Fax:603-895-4944
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH018462-23-05363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health