Provider Demographics
NPI:1831655885
Name:PINKSTON-MIZELL, CAMYLA DEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CAMYLA
Middle Name:DEE
Last Name:PINKSTON-MIZELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3967 DELHI AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45204-1264
Mailing Address - Country:US
Mailing Address - Phone:513-544-5094
Mailing Address - Fax:
Practice Address - Street 1:3967 DELHI AVE APT 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45204-1264
Practice Address - Country:US
Practice Address - Phone:513-544-5094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH168822164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH168822OtherLICENSE NUMBER (LPN)