Basic Information
| Provider Information | |||||||||
| NPI: | 1659373249 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIZGALA | ||||||||
| FirstName: | LIANE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 933 RED APPLE RD STE D | ||||||||
| Address2: | CENTRAL WASHINGTON HOSPITAL WOMEN'S HEALTHCARE CENTER | ||||||||
| City: | WENATCHEE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988013370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096656125 | ||||||||
| FaxNumber: | 5096656124 | ||||||||
| Practice Location | |||||||||
| Address1: | 933 RED APPLE RD STE D | ||||||||
| Address2: | CENTRAL WASHINGTON HOSPITAL WOMEN'S HEALTHCARE CENTER | ||||||||
| City: | WENATCHEE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988013370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096656125 | ||||||||
| FaxNumber: | 5096656124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 09/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD00035444 | WA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 8212854 | 05 | WA | MEDICAID |