Healthcare Provider Details

I. General information

NPI: 1467702233
Provider Name (Legal Business Name): BRANDYE MICHELLE MIZE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC BAVARIA CMR 411, BLDG 700, ROSE BARRACKS
APO AE
09112-0061
US

IV. Provider business mailing address

USA MEDDAC BAVARIA CMR 411, BLDG 700, ROSE BARRACKS
APO AE
09112-0061
US

V. Phone/Fax

Practice location:
  • Phone: 011499662834719
  • Fax: 011499662834721
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number689442
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number689442
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: