Provider Demographics
NPI:1528424769
Name:MIZE, KRISTY BEIGE (LPN/LVN)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:BEIGE
Last Name:MIZE
Suffix:
Gender:F
Credentials:LPN/LVN
Other - Prefix:MRS
Other - First Name:KRISTY
Other - Middle Name:BEIGE
Other - Last Name:STARWALT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN/LVN
Mailing Address - Street 1:9040 REID STREET, ATTN:MCHJ-CLQ-C
Mailing Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1000
Mailing Address - Country:US
Mailing Address - Phone:253-968-1110
Mailing Address - Fax:877-874-1031
Practice Address - Street 1:9040 REID STREET, ATTN:MCHJ-CLQ-C
Practice Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1000
Practice Address - Country:US
Practice Address - Phone:253-968-1110
Practice Address - Fax:877-874-1031
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00057652164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse