Healthcare Provider Details

I. General information

NPI: 1003455742
Provider Name (Legal Business Name): LISA KRISTINE MIZEUR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2019
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NE NEFF RD
BEND OR
97701-6337
US

IV. Provider business mailing address

5100 GOLDEN HILL DR
WEED CA
96094-9644
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-4800
  • Fax: 541-706-4806
Mailing address:
  • Phone: 530-356-5342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95013410
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202100982NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: