Provider Demographics
NPI:1700108545
Name:OBRIEN-MAZZA, KAREN L (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:L
Last Name:OBRIEN-MAZZA
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 1:4434 CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-2420
Mailing Address - Country:US
Mailing Address - Phone:315-299-6345
Mailing Address - Fax:
Practice Address - Street 1:2105 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-1698
Practice Address - Country:US
Practice Address - Phone:315-468-3239
Practice Address - Fax:315-468-2917
Is Sole Proprietor?:No
Enumeration Date:2010-02-21
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186262-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY186262-1OtherLPN LICENSE