Provider Demographics
NPI:1174153159
Name:MIZE, BLAIR (MS, RDN, CSSD, LDN)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:MIZE
Suffix:
Gender:F
Credentials:MS, RDN, CSSD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6263 POPLAR AVE STE 605
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4724
Mailing Address - Country:US
Mailing Address - Phone:901-343-6146
Mailing Address - Fax:901-328-1802
Practice Address - Street 1:6263 POPLAR AVE STE 605
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4724
Practice Address - Country:US
Practice Address - Phone:901-343-6146
Practice Address - Fax:901-328-1802
Is Sole Proprietor?:No
Enumeration Date:2020-01-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered