Provider Demographics
NPI:1851450159
Name:MOZONE MARSHALL, DENISE EVETTE (DNP,APRN,CPNP-PC)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:EVETTE
Last Name:MOZONE MARSHALL
Suffix:
Gender:F
Credentials:DNP,APRN,CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 CLAIRE ST
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:TX
Mailing Address - Zip Code:76226-5537
Mailing Address - Country:US
Mailing Address - Phone:972-302-3422
Mailing Address - Fax:
Practice Address - Street 1:76 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3305
Practice Address - Country:US
Practice Address - Phone:860-545-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113086208000000X
AZAP5053363LP0200X
CT13966363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ821778Medicaid