Healthcare Provider Details

I. General information

NPI: 1861316945
Provider Name (Legal Business Name): AMBER HAZLEWOOD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

886 US-411
ETOWAH TN
37331
US

IV. Provider business mailing address

118 MINNIE LN
BENTON TN
37307-5833
US

V. Phone/Fax

Practice location:
  • Phone: 423-263-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number262601
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: