MEDICARE: ELIZABETH MUTIZWA

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1235548652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MUTIZWA

Provider Business Mailing Address
First Line	:	1936 CLIFFROSE DR
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-5790
Country	:	US
Telephone Number	:	469-219-1827
Fax Number	:

Provider Business Practice Location Address
First Line	:	1936 CLIFFROSE DR
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-5790
Country	:	US
Telephone Number	:	469-219-1827
Fax Number	:

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

Provider Enumeration Date	:	08/11/2014
Last Update Date	:	08/11/2014

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Directions to “ ELIZABETH MUTIZWA ” Practice Location

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