MEDICARE: DEBORAH MIZE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC1500X	Community Health Registered Nurse	200142114RN	NY
2	163WG0000X	General Practice Registered Nurse	200142114RN	OR
3	163WG0600X	Gerontology Registered Nurse	200142114RN	OR

General Provider Information

NPI Number	:	1063796001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH MIZE RN

Provider Business Mailing Address
First Line	:	1021 LAKESHORE RD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-3708
Country	:	US
Telephone Number	:	503-635-1928
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 LAKESHORE RD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-3708
Country	:	US
Telephone Number	:	503-635-1928
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	10/10/2011

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