Provider Demographics
NPI:1386207512
Name:MIZE, MCKINLEY (RN)
Entity Type:Individual
Prefix:
First Name:MCKINLEY
Middle Name:
Last Name:MIZE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 THOMAS LAKE HARRIS DR UNIT 313
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-0195
Mailing Address - Country:US
Mailing Address - Phone:619-203-5758
Mailing Address - Fax:
Practice Address - Street 1:4623 THOMAS LAKE HARRIS DR UNIT 313
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-0195
Practice Address - Country:US
Practice Address - Phone:619-203-5758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-14
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95332932163WP0808X
TNAPN0000025738363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health