Mizuba, Mark

Mizuba, Mark is an individual health care provider with primary practice located at 1970 Roanoke Blvd , Salem VA 24153-6404. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Mizuba, Mark can be contacted via phone (540) 982-2463.

Contact Information

Primary practice address
1970 Roanoke Blvd Salem VA 24153-6404
Phone: (540) 982-2463
Fax: (540) 983-1090
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 0024166707 Virginia

Profile Details

NPI number 1164439899
LBN Legal business name Mizuba, Mark
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 2nd, 2006
Last updated Apr 28th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164439899 NPPES
Virginia MEDICAID 010218608
Virginia MEDICAID 010218641
Virginia MEDICAID 010218632
Virginia MEDICAID 010218705
Virginia MEDICAID 010218748

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