Healthcare Provider Details

I. General information

NPI: 1801663133
Provider Name (Legal Business Name): EMMA K HAZEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LOCKWOOD ST FL 6
PROVIDENCE RI
02903-4801
US

IV. Provider business mailing address

192 WEST ST
ATTLEBORO MA
02703-2637
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-9166
  • Fax:
Mailing address:
  • Phone: 508-361-3966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN59052
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN03913
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: