Provider Demographics
NPI:1649873191
Name:MAZE, JOHN A (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:MAZE
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 STACEY DR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-1832
Mailing Address - Country:US
Mailing Address - Phone:816-352-6190
Mailing Address - Fax:
Practice Address - Street 1:25201 E. 78 HWY
Practice Address - Street 2:BUILDING #5 MEDICAL
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64056
Practice Address - Country:US
Practice Address - Phone:816-695-4541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO133500163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health