Healthcare Provider Details

I. General information

NPI: 1962981324
Provider Name (Legal Business Name): ELIZABETH ANNE MIER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 EMELINE AVE
SANTA CRUZ CA
95060-1966
US

IV. Provider business mailing address

1060 EMELINE AVE
SANTA CRUZ CA
95060-1966
US

V. Phone/Fax

Practice location:
  • Phone: 831-291-7539
  • Fax:
Mailing address:
  • Phone: 831-291-7539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number833415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: