Provider Demographics
NPI:1427318989
Name:ANZALONE, MARIA M (ANP)
Entity type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:M
Last Name:ANZALONE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 30
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230
Mailing Address - Country:US
Mailing Address - Phone:413-528-9311
Mailing Address - Fax:413-644-0274
Practice Address - Street 1:71 HOSPITAL AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247
Practice Address - Country:US
Practice Address - Phone:413-664-4088
Practice Address - Fax:413-663-6405
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA177863363LA2200X
MARN177863363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health