Provider Demographics
NPI:1154912897
Name:MAZUR, DINA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:MAZUR
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NE MOTHER JOSEPH PL
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3200
Mailing Address - Country:US
Mailing Address - Phone:360-514-2000
Mailing Address - Fax:360-514-3932
Practice Address - Street 1:200 NE MOTHER JOSEPH PL STE 400
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3290
Practice Address - Country:US
Practice Address - Phone:360-514-4444
Practice Address - Fax:360-514-6530
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60000871163W00000X
WAAP61060253363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse