Provider Demographics
NPI:1528104536
Name:MAZUL, MARY C (CNM)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:MAZUL
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:5000 W CHAMBERS ST
Mailing Address - Street 2:ST. JOSEPH REGIONAL MEDICAL CTR-WOMEN'S OUTPATIENT CTR
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1650
Mailing Address - Country:US
Mailing Address - Phone:414-447-2275
Mailing Address - Fax:414-874-4045
Practice Address - Street 1:5000 W CHAMBERS ST
Practice Address - Street 2:ST. JOSEPH REGIONAL MEDICAL CTR-WOMEN'S OUTPATIENT CTR
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1650
Practice Address - Country:US
Practice Address - Phone:414-447-2275
Practice Address - Fax:414-874-4045
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2014-02-07
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Provider Licenses
StateLicense IDTaxonomies
WI122697-032367A00000X
WI4774363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39905800Medicaid
WI39905800Medicaid