Healthcare Provider Details

I. General information

NPI: 1306773353
Provider Name (Legal Business Name): EMILY WARD MIZELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 EDGEMONT RD
WENDELL NC
27591-7875
US

IV. Provider business mailing address

916 EDGEMONT RD
WENDELL NC
27591-7875
US

V. Phone/Fax

Practice location:
  • Phone: 919-432-8085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number301496
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: