Provider Demographics
NPI:1205578242
Name:MIZELLE, MARIAN TAYLOR STRANGE (PA-C)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:TAYLOR STRANGE
Last Name:MIZELLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:TAYLOR
Other - Last Name:STRANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4101
Mailing Address - Country:US
Mailing Address - Phone:434-792-0423
Mailing Address - Fax:
Practice Address - Street 1:117 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4101
Practice Address - Country:US
Practice Address - Phone:434-792-0423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant