Healthcare Provider Details

I. General information

NPI: 1295181741
Provider Name (Legal Business Name): JENNY MIZZELL RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 BAKER DR
BIRMINGHAM AL
35213-2103
US

IV. Provider business mailing address

509 BAKER DR
BIRMINGHAM AL
35213-2103
US

V. Phone/Fax

Practice location:
  • Phone: 334-524-8880
  • Fax:
Mailing address:
  • Phone: 334-524-8880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-75562
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: