Individual provider Active NPI

Isabella Lara Mizels, CPNP-PC

  • Pediatric Nurse Practitioner
  • Salt Lake City, UT
National Provider Identifier
1912608159
Registry record updated Dec 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
13284667-4405 Issued in UT
Practice address
100 N Mario Capecchi Dr
Salt Lake City, UT 84113-1103
Phone
(801) 662-1000
NPI assigned
Mar 14, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 13284667-4405 UT
Pediatric Nurse Practitioner 363LP0200X 13284667-4405 UT Primary

Addresses

Primary practice location

100 N Mario Capecchi Dr
Salt Lake City, UT 84113-1103

Mailing address

PO Box 30180
Salt Lake City, UT 84130-0180

Other practice location 1

640 E Wilmington Ave Unit A508
Salt Lake City, UT 84106-1004
Phone (321) 480-6030

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230817000710 UT Practitioner - Nurse Practitioner 4587026992 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
13284667-4405UTMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc Nurse Practitioner Current Accepting new patients
Ihc Health Services Inc CurrentSince Aug 1, 2023 Accepting new patients
Ihc Health Services, Inc. CurrentSince Aug 1, 2023 Accepting new patients

Locations

100 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 587-7109

1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992

1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701561600000",
    "number": "1912608159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30180",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841300180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N MARIO CAPECCHI DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103",
            "telephone_number": "801-662-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 E Wilmington Ave Unit A508",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841061004",
            "country_code": "US",
            "telephone_number": "321-480-6030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIZELS",
        "first_name": "ISABELLA",
        "middle_name": "LARA",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-14",
        "last_updated": "2023-12-03",
        "certification_date": "2023-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "13284667-4405",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "UT",
            "license": "13284667-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.