Provider Demographics
NPI:1336754977
Name:DIZON, IZEE MER (MSN, RN, APN)
Entity type:Individual
Prefix:MR
First Name:IZEE MER
Middle Name:
Last Name:DIZON
Suffix:
Gender:M
Credentials:MSN, RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2752
Mailing Address - Country:US
Mailing Address - Phone:908-300-4598
Mailing Address - Fax:
Practice Address - Street 1:77 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2752
Practice Address - Country:US
Practice Address - Phone:908-300-4598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01051800363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology