Provider Demographics
NPI:1245205384
Name:BIZZELL, NANCY EVELYN (MD)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:EVELYN
Last Name:BIZZELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 - C OLD CHARLOTTE HWY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110
Mailing Address - Country:US
Mailing Address - Phone:704-282-2400
Mailing Address - Fax:704-282-2422
Practice Address - Street 1:3016 - C OLD CHARLOTTE HWY
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110
Practice Address - Country:US
Practice Address - Phone:704-282-2400
Practice Address - Fax:704-282-2422
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC281302083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC82827Medicare UPIN