Provider Demographics
NPI:1497935993
Name:CROWLEY-MIZE, ALICE
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:CROWLEY-MIZE
Suffix:
Gender:F
Credentials:
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 118
Mailing Address - Street 2:
Mailing Address - City:JORDAN VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97910-0118
Mailing Address - Country:US
Mailing Address - Phone:541-586-2422
Mailing Address - Fax:541-586-2419
Practice Address - Street 1:400 IOWA AVE
Practice Address - Street 2:
Practice Address - City:JORDAN VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97910-0118
Practice Address - Country:US
Practice Address - Phone:541-586-2422
Practice Address - Fax:541-586-2419
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01223363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical