Provider Demographics
NPI:1548507791
Name:MAZZA-CONGROVE, GIULIANA (CRNP)
Entity type:Individual
Prefix:
First Name:GIULIANA
Middle Name:
Last Name:MAZZA-CONGROVE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 GREENE PLZ
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-8142
Mailing Address - Country:US
Mailing Address - Phone:724-627-2756
Mailing Address - Fax:
Practice Address - Street 1:130 GREENE PLZ
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8142
Practice Address - Country:US
Practice Address - Phone:724-627-2756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030129363LP0808X
PASP012615363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0154337Medicaid
WV1548507791Medicaid