Basic Information
| Provider Information | |||||||||
| NPI: | 1003455742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIZEUR | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | KRISTINE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5100 GOLDEN HILL DR | ||||||||
| Address2: | |||||||||
| City: | WEED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960949644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303565342 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2600 NE NEFF RD | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977016337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417064800 | ||||||||
| FaxNumber: | 5417064806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2019 | ||||||||
| LastUpdateDate: | 10/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 95013410 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.