Provider Demographics
NPI:1750496352
Name:MIZRO, ELIZABETH (MS, ANP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:MIZRO
Suffix:
Gender:F
Credentials:MS, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LANSING ST
Mailing Address - Street 2:HOSPITALISTS DEPT
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1983
Mailing Address - Country:US
Mailing Address - Phone:315-255-7438
Mailing Address - Fax:315-255-7099
Practice Address - Street 1:17 LANSING ST
Practice Address - Street 2:AUBURN MEMORIAL HOSPITAL / HOSPITALISTS DEPT
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1983
Practice Address - Country:US
Practice Address - Phone:315-255-7011
Practice Address - Fax:315-255-7099
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300466-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01954118Medicaid
NY01954118Medicaid
NYBB4025Medicare PIN