Healthcare Provider Details

I. General information

NPI: 1154987691
Provider Name (Legal Business Name): SHIRLEY JEAN MIZELL RN, HEALTH EDUCATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 HACKBERRY LN
TUSCALOOSA AL
35401-4922
US

IV. Provider business mailing address

1013 ORCHARD MILL RD
COTTONDALE AL
35453-1457
US

V. Phone/Fax

Practice location:
  • Phone: 833-855-5777
  • Fax:
Mailing address:
  • Phone: 205-799-9886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: