Healthcare Provider Details

I. General information

NPI: 1083793137
Provider Name (Legal Business Name): THERESA MARIE MIZER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 WASHINGTON ST
STEUBENVILLE OH
43952-2122
US

IV. Provider business mailing address

213 W MARKET ST
CADIZ OH
43907-1109
US

V. Phone/Fax

Practice location:
  • Phone: 740-282-5676
  • Fax: 740-284-1640
Mailing address:
  • Phone: 740-942-2034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number01843
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: