Mandziara, Mary A

Mandziara, Mary A is an individual health care provider with primary practice located at 19229 Mack Ave Suite 34, Grosse Pointe Woods MI 48236-2858. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Acute Care, which is considered as her primary health care specialty. Mandziara, Mary A can be contacted via phone (313) 647-3245.

Contact Information

Primary practice address
19229 Mack Ave Suite 34 Grosse Pointe Woods MI 48236-2858
Phone: (313) 647-3245
Fax: (313) 647-3244
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 4704131950 Michigan

Profile Details

NPI number 1669568341
LBN Legal business name Mandziara, Mary A
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 4th, 2006
Last updated Oct 24th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669568341 NPPES
Massachusetts MEDICAID 4327582
Massachusetts Other 0866737
Massachusetts Other 4704131950

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