Provider Demographics
NPI:1295181741
Name:MIZZELL, JENNY (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:MIZZELL
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 BAKER DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-2103
Mailing Address - Country:US
Mailing Address - Phone:334-524-8880
Mailing Address - Fax:
Practice Address - Street 1:509 BAKER DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-2103
Practice Address - Country:US
Practice Address - Phone:334-524-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL-75562174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN