Healthcare Provider Details

I. General information

NPI: 1225042658
Provider Name (Legal Business Name): MARY DARLENE HAZARD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7286 BUTTERFLY CIR
SPANISH FORT AL
36527-4040
US

IV. Provider business mailing address

1201 MONTLIMAR DR STE 100
MOBILE AL
36609-1718
US

V. Phone/Fax

Practice location:
  • Phone: 251-509-5347
  • Fax: 479-201-0668
Mailing address:
  • Phone: 251-343-0989
  • Fax: 251-343-0792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-056988
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: