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Individual

KRISTEN J MIZUMOTO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
5930 HEISLEY RD, NEIGHBORING, MENTOR, OH 44060-1834
(440) 639-3509
(440) 352-2040
Mailing address
5930 HEISLEY RD, NEIGHBORING, MENTOR, OH 44060-1834
(440) 639-3509
(440) 352-2040

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
COA13309
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2362429
OH
Enumeration date
09/13/2012
Last updated
01/31/2014
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