Provider Demographics
NPI:1003049768
Name:MIZNER, NICOLE L (CPNP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:L
Last Name:MIZNER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
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Mailing Address - Street 1:887 CONGRESS ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3100
Mailing Address - Country:US
Mailing Address - Phone:207-773-2723
Mailing Address - Fax:207-773-3941
Practice Address - Street 1:887 CONGRESS ST
Practice Address - Street 2:SUITE 310
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3100
Practice Address - Country:US
Practice Address - Phone:207-773-2723
Practice Address - Fax:207-773-3941
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEAP091039363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics