Provider Demographics
NPI:1346068715
Name:MAZANEC, NICOLE KRISTINE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:KRISTINE
Last Name:MAZANEC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7152 WELLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63143-3502
Mailing Address - Country:US
Mailing Address - Phone:314-623-5240
Mailing Address - Fax:
Practice Address - Street 1:7152 WELLINGTON CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63143-3502
Practice Address - Country:US
Practice Address - Phone:314-623-5240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula