Individual provider Active NPI

Karen L Obrien-Mazza, LPN

  • Licensed Practical Nurse
  • Syracuse, NY
National Provider Identifier
1700108545
Registry record updated Feb 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
186262-1 Issued in NY
Practice address
2105 W Genesee St
Syracuse, NY 13219-1698
Phone
(315) 468-3239
Fax
(315) 468-2917
NPI assigned
Feb 21, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 186262-1 NY Primary

Addresses

Primary practice location

2105 W Genesee St
Syracuse, NY 13219-1698

Mailing address

4434 Cleveland Rd
Syracuse, NY 13215-2420
Phone (315) 299-6345

Other identifiers 1

IdentifierTypeStateIssuer
186262-1OtherNYLPN LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
186262-1NYMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266710400000",
    "number": "1700108545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4434 CLEVELAND RD",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132152420",
            "telephone_number": "315-299-6345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 W GENESEE ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132191698",
            "telephone_number": "315-468-3239",
            "fax_number": "315-468-2917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBRIEN-MAZZA",
        "first_name": "KAREN",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-21",
        "last_updated": "2010-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "186262-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPN LICENSE",
            "identifier": "186262-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.