Provider Demographics
NPI:1326703968
Name:MIZELL, MAKENZIE ZOE (BSN, RN, MSN)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:ZOE
Last Name:MIZELL
Suffix:
Gender:F
Credentials:BSN, RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4113 MURFREESBORO RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-4062
Mailing Address - Country:US
Mailing Address - Phone:931-309-7713
Mailing Address - Fax:
Practice Address - Street 1:4037 RURAL PLAINS CIR STE 150
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-1868
Practice Address - Country:US
Practice Address - Phone:615-550-5880
Practice Address - Fax:615-559-5889
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
TN0000255872163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No291U00000XLaboratoriesClinical Medical Laboratory