Healthcare Provider Details

I. General information

NPI: 1770950875
Provider Name (Legal Business Name): BRYAN MIZNER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 09/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3203 OSBORNE DR W STE 101
HASTINGS NE
68901-9122
US

IV. Provider business mailing address

720 N WEBB RD
GRAND ISLAND NE
68803-3310
US

V. Phone/Fax

Practice location:
  • Phone: 402-834-1005
  • Fax: 402-303-1022
Mailing address:
  • Phone: 308-384-2500
  • Fax: 308-384-2565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: