Healthcare Provider Details

I. General information

NPI: 1568896942
Provider Name (Legal Business Name): ANNELIESE HEATHER MIZWICKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SPEAR ST STE 120
SAN FRANCISCO CA
94105-1674
US

IV. Provider business mailing address

2511 SACRAMENTO ST APT 1
SAN FRANCISCO CA
94115-2231
US

V. Phone/Fax

Practice location:
  • Phone: 415-612-3275
  • Fax:
Mailing address:
  • Phone: 847-845-8694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: