Provider Demographics
NPI:1356338172
Name:MAZZOLA, KATHLEEN (CRNP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:MAZZOLA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HOT METAL ST
Mailing Address - Street 2:QUANTUM ONE, N431
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2348
Mailing Address - Country:US
Mailing Address - Phone:412-432-5806
Mailing Address - Fax:412-432-7691
Practice Address - Street 1:470 JOHNSON RD
Practice Address - Street 2:SUITE 10
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-8944
Practice Address - Country:US
Practice Address - Phone:724-223-3816
Practice Address - Fax:724-223-4079
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008607363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP008607OtherNURSE PRACTITIONER
PARN202342LOtherREGISTERED NURSE
PA1824822OtherSECURITY BLUE
PARN202342LOtherREGISTERED NURSE
PA097869F6VMedicare PIN