Healthcare Provider Details

I. General information

NPI: 1982632246
Provider Name (Legal Business Name): NANCY RUTH HAZLE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WALNUT ST 14TH FLOOR
PHILADELPHIA PA
19107-5109
US

IV. Provider business mailing address

800 WALNUT ST 14TH FLOOR
PHILADELPHIA PA
19107-5109
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-8000
  • Fax: 215-829-8623
Mailing address:
  • Phone: 215-829-8000
  • Fax: 215-829-8623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW008403L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: