Healthcare Provider Details

I. General information

NPI: 1386207512
Provider Name (Legal Business Name): MCKINLEY MIZE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2019
Last Update Date: 09/11/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 48TH ST
SACRAMENTO CA
95817-1541
US

IV. Provider business mailing address

4623 THOMAS LAKE HARRIS DR UNIT 311
SANTA ROSA CA
95403-0195
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2145
  • Fax:
Mailing address:
  • Phone: 619-203-5758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95332932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: