Healthcare Provider Details

I. General information

NPI: 1902036130
Provider Name (Legal Business Name): KATHERINE MIZE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E WASHINGTON BLVD SUITE 100
CRESCENT CITY CA
95531-8160
US

IV. Provider business mailing address

670 9TH ST SUITE 203
ARCATA CA
95521-6248
US

V. Phone/Fax

Practice location:
  • Phone: 707-465-6925
  • Fax: 707-465-6070
Mailing address:
  • Phone: 707-826-8633
  • Fax: 707-826-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number752719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: