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General NPI Number Information
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NPI Number | 1598429052
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Entity Type | Individual
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Provider Name | MARIAH HAZEN NP
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Gender | Female
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Dates
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Enumeration Date | 10/29/2021
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 823 ELM ST STE 200
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4164
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Country | US
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Telephone | 910-580-8195
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Fax | 318-906-4613
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Provider Business Mailing Address
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Address Line | PO BOX 48072
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City | CUMBERLAND
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State | NC
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Zip | 28331-8072
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Country | US
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Telephone | 910-580-8195
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Fax | 910-828-2934
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 200446
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License Number State | NC
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