Individual
MARY A MANDZIARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
19229 MACK AVE, SUITE 34, GROSSE POINTE WOODS, MI 48236-2858
(313) 647-3245
(313) 647-3244
Mailing address
19229 MACK AVE, SUITE 23, GROSSE POINTE WOODS, MI 48236-2858
(313) 647-3245
(313) 647-3244
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704131950
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0866737
BCBSM PIN
MI
05
—
4327582
—
MA
01
—
4704131950
MICHIGAN LICENSE
MI
Enumeration date
10/04/2006
Last updated
10/24/2014
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