Provider Demographics
NPI:1568896942
Name:MIZWICKI, ANNELIESE HEATHER (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNELIESE
Middle Name:HEATHER
Last Name:MIZWICKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 SACRAMENTO ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2231
Mailing Address - Country:US
Mailing Address - Phone:847-845-8694
Mailing Address - Fax:
Practice Address - Street 1:345 SPEAR ST STE 120
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-1674
Practice Address - Country:US
Practice Address - Phone:415-612-3275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant