Healthcare Provider Details

I. General information

NPI: 1467465302
Provider Name (Legal Business Name): NOVELINE HASBARGEN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2187 N VICKEY ST
FLAGSTAFF AZ
86004-6106
US

IV. Provider business mailing address

2187 N VICKEY ST
FLAGSTAFF AZ
86004-6106
US

V. Phone/Fax

Practice location:
  • Phone: 928-714-6401
  • Fax: 928-714-6480
Mailing address:
  • Phone: 928-714-6401
  • Fax: 928-714-6480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLP-011166
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: