Provider Demographics
NPI:1053811844
Name:MAZZUCOLA, SOMER ROSE (DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:SOMER
Middle Name:ROSE
Last Name:MAZZUCOLA
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-7325
Mailing Address - Country:US
Mailing Address - Phone:931-241-0429
Mailing Address - Fax:
Practice Address - Street 1:820 N MONTANA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3856
Practice Address - Country:US
Practice Address - Phone:406-443-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-129234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily