Provider Demographics
NPI:1386006765
Name:MIZERA-MICHOLYCHAK, ALISON (NP)
Entity Type:Individual
Prefix:MISS
First Name:ALISON
Middle Name:
Last Name:MIZERA-MICHOLYCHAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:MIZERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:33 LEWIS RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1040
Mailing Address - Country:US
Mailing Address - Phone:607-729-8156
Mailing Address - Fax:607-729-3982
Practice Address - Street 1:4417 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850
Practice Address - Country:US
Practice Address - Phone:607-797-1251
Practice Address - Fax:607-729-4393
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340056363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics