Provider Demographics
NPI:1356122659
Name:BIZZAK, ALICE
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:BIZZAK
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 1:546 KATYS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756-6008
Mailing Address - Country:US
Mailing Address - Phone:570-316-3466
Mailing Address - Fax:
Practice Address - Street 1:546 KATYS CHURCH RD
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-6008
Practice Address - Country:US
Practice Address - Phone:570-316-3466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028337363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology