MEDICARE: HAZAEL SHAKUR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LPO43693	AZ

General Provider Information

NPI Number	:	1003230970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAZAEL SHAKUR

Provider Business Mailing Address
First Line	:	3848 N 3RD AVE UNIT 2019
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-3461
Country	:	US
Telephone Number	:	602-435-3535
Fax Number	:

Provider Business Practice Location Address
First Line	:	3848 N 3RD AVE UNIT 2019
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-3461
Country	:	US
Telephone Number	:	602-435-3535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2014
Last Update Date	:	02/12/2014

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