Healthcare Provider Details

I. General information

NPI: 1851751242
Provider Name (Legal Business Name): KATY MIZIKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4934 PEACH ST
ERIE PA
16509-2043
US

IV. Provider business mailing address

4934 PEACH ST
ERIE PA
16509-2043
US

V. Phone/Fax

Practice location:
  • Phone: 814-868-5487
  • Fax:
Mailing address:
  • Phone: 814-868-5487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberF03052
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: