Provider Demographics
NPI:1770747099
Name:MAZANEK, MARCIN WOJCIECH X (PT)
Entity type:Individual
Prefix:MR
First Name:MARCIN
Middle Name:WOJCIECH
Last Name:MAZANEK
Suffix:X
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 YEISER DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-1288
Mailing Address - Country:US
Mailing Address - Phone:731-926-3647
Mailing Address - Fax:
Practice Address - Street 1:1645 FLORENCE RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-5210
Practice Address - Country:US
Practice Address - Phone:731-926-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3652314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility