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General NPI Number Information
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NPI Number | 1063796001
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Entity Type | Individual
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Provider Name | DEBORAH MIZE RN
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Gender | Female
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 1021 LAKESHORE RD
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-3708
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Country | US
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Telephone | 503-635-1928
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 LAKESHORE RD
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-3708
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Country | US
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Telephone | 503-635-1928
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Fax |
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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 | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 200142114RN
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 200142114RN
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 163WG0600X
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Taxonomy Name | Gerontology Registered Nurse
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License Number | 200142114RN
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License Number State | OR
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