Individual
KATHRYN GRACE MAZZARELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1275 YORK AVE, NEW YORK, NY 10065
(516) 647-2075
Mailing address
1275 YORK AVE, NEW YORK, NY 10065-6007
(516) 647-2075
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
927502
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376842601
—
TX
05
—
376842602
—
TX
Enumeration date
08/01/2017
Last updated
11/09/2018
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