Healthcare Provider Details

I. General information

NPI: 1881178036
Provider Name (Legal Business Name): KIMBERLYN MIZERA-LIESKE ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2018
Last Update Date: 09/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 N 91ST ST STE A115
SCOTTSDALE AZ
85258-5036
US

IV. Provider business mailing address

8175 E EVANS RD UNIT 15101
SCOTTSDALE AZ
85267-5080
US

V. Phone/Fax

Practice location:
  • Phone: 480-616-2549
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number18-1734
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: