Provider Demographics
NPI:1407092372
Name:KINZER, LIZETTE RENE (LMT, BEO)
Entity Type:Individual
Prefix:MS
First Name:LIZETTE
Middle Name:RENE
Last Name:KINZER
Suffix:
Gender:F
Credentials:LMT, BEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-0021
Mailing Address - Country:US
Mailing Address - Phone:808-573-9081
Mailing Address - Fax:808-573-9081
Practice Address - Street 1:3537 BALDWIN AVE APT A
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-9545
Practice Address - Country:US
Practice Address - Phone:808-573-9081
Practice Address - Fax:808-573-9081
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 6245171W00000X
HIBEO 16589171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor