Healthcare Provider Details

I. General information

NPI: 1649099342
Provider Name (Legal Business Name): JAIMEE JEAN MIZE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3097 PRAIRIE ST SW
GRANDVILLE MI
49418-2000
US

IV. Provider business mailing address

5043 NEW ORLEANS DR NE
ROCKFORD MI
49341-9302
US

V. Phone/Fax

Practice location:
  • Phone: 616-531-9973
  • Fax:
Mailing address:
  • Phone: 616-250-0639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number4704297300
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: