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General NPI Number Information
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NPI Number | 1558770420
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Entity Type | Individual
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Provider Name | CASEY LEIGH HAZENBERG
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Gender | Female
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 08/23/2015
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Provider Practice Location Address
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Address Line | 1049 EDGEWATER ST NW
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City | SALEM
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State | OR
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Zip | 97304-4046
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Country | US
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Telephone | 503-814-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 1049 EDGEWATER ST NW
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City | SALEM
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State | OR
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Zip | 97304-4046
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Country | US
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Telephone | 503-814-4400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201404739NP-PP
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License Number State | OR
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