Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 22064 | SC |
N | 363LA2200X | Nurse Practitioner - Adult Health | 22064 | SC |
N | 363LA2200X | Nurse Practitioner - Adult Health | F302704-1 | NY |
NPI | 1023452992 |
---|---|
Provider Name | Ms. Alice M Mazzella |
First Address | Charleston, SC 29406-9143 |
Second Address | Charleston, SC 29406-9143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2013 |
Last Update Date | 27/01/2022 |