1013110576 NPI number — MRS. MARY KATHRYN KAZANOWSKI ARNP

Table of content: MRS. MARY KATHRYN KAZANOWSKI ARNP (NPI 1013110576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013110576 NPI number — MRS. MARY KATHRYN KAZANOWSKI ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAZANOWSKI
Provider First Name:
MARY
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KAZANOWSKI
Provider Other First Name:
MARY
Provider Other Middle Name:
KATHRYN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1013110576
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 WEYMOUTH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03110-5025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-472-2550
Provider Business Mailing Address Fax Number:
603-472-3933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 LANGFORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAYMOND
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03077-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-895-9303
Provider Business Practice Location Address Fax Number:
603-895-4944
Provider Enumeration Date:
06/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  018462-23-05 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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