Provider Demographics
NPI:1992817571
Name:MIZE, TAMMY JOAN (MS RD LD)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:JOAN
Last Name:MIZE
Suffix:
Gender:F
Credentials:MS RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11478 S WILDER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061
Mailing Address - Country:US
Mailing Address - Phone:913-397-8048
Mailing Address - Fax:
Practice Address - Street 1:2100 BAPTISTE DR
Practice Address - Street 2:MIAMI COUNTY MEDICAL CENTER
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071
Practice Address - Country:US
Practice Address - Phone:913-294-6656
Practice Address - Fax:913-294-6639
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1274133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
130644Medicare ID - Type Unspecified