Provider Demographics
NPI:1063796001
Name:MIZE, DEBORAH (RN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MIZE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 LAKESHORE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3708
Mailing Address - Country:US
Mailing Address - Phone:503-635-1928
Mailing Address - Fax:
Practice Address - Street 1:1021 LAKESHORE RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3708
Practice Address - Country:US
Practice Address - Phone:503-635-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200142114RN163WC1500X
OR200142114RN163WG0000X, 163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology