Individual
MARK MIZUBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 853-0222
(540) 981-7855
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024166707
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010218608
—
VA
05
—
010218632
—
VA
05
—
010218641
—
VA
05
—
010218705
—
VA
05
—
010218748
—
VA
Enumeration date
08/02/2006
Last updated
12/22/2025
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