Provider Demographics
NPI:1649470246
Name:MASCARI, MARY A (LPN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:A
Last Name:MASCARI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 W WOODFIELD
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-9464
Mailing Address - Country:US
Mailing Address - Phone:614-905-7275
Mailing Address - Fax:
Practice Address - Street 1:24 W WOODFIELD
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-9464
Practice Address - Country:US
Practice Address - Phone:614-905-7275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN104017164W00000X, 246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2125275Medicaid