Healthcare Provider Details

I. General information

NPI: 1801677539
Provider Name (Legal Business Name): RENATE MIZE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 FLEISCHMANN WAY
CARSON CITY NV
89703-2995
US

IV. Provider business mailing address

PO BOX 6802
STATELINE NV
89449-6802
US

V. Phone/Fax

Practice location:
  • Phone: 775-445-7350
  • Fax:
Mailing address:
  • Phone: 775-588-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number63140
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: