Individual
AUTUMN MAZZELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
900 VIRGINIA ST E STE 400, CHARLESTON, WV 25301-2835
(681) 313-4759
Mailing address
3836 SLEEPY HOLLOW DR, HURRICANE, WV 25526-9148
(304) 619-9489
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
39889
WV
Other
Enumeration date
03/05/2025
Last updated
03/05/2025
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