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General NPI Number Information
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NPI Number | 1043354301
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Entity Type | Individual
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Provider Name | PAMALA DAWN MIZE M.S. CCC-A
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Gender | Female
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 360 VIRGINIA AVE
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City | WYTHEVILLE
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State | VA
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Zip | 24382-1185
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Country | US
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Telephone | 276-620-3546
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Fax | 276-228-3546
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Provider Business Mailing Address
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Address Line | 195 W PINE ST # 103
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City | WYTHEVILLE
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State | VA
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Zip | 24382-1954
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Country | US
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Telephone | 276-620-3546
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Fax | 276-228-3546
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2201000232
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License Number State | VA
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