Provider Demographics
NPI:1720241516
Name:MAZZAFERRI, LAURA A (CPMP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:MAZZAFERRI
Suffix:
Gender:F
Credentials:CPMP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANNE
Other - Last Name:MAZZAFERRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:10 WOODLAKE TRL
Mailing Address - Street 2:SUITE C
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9573
Mailing Address - Country:US
Mailing Address - Phone:740-392-7337
Mailing Address - Fax:740-392-7333
Practice Address - Street 1:29 A NORTH CLAYTON #749
Practice Address - Street 2:
Practice Address - City:CENTERBURG
Practice Address - State:OH
Practice Address - Zip Code:43011-0749
Practice Address - Country:US
Practice Address - Phone:740-625-5326
Practice Address - Fax:740-625-5965
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN252834COA1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics