MEDICARE: NEDRA HAZLETT CRNP

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	363L00000X	Nurse Practitioner	RN193623L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255304002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEDRA HAZLETT CRNP

Provider Business Mailing Address
First Line	:	1709 UNION AVE
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-2104
Country	:	US
Telephone Number	:	724-226-8711
Fax Number	:	724-226-0555

Provider Business Practice Location Address
First Line	:	1709 UNION AVE
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-2104
Country	:	US
Telephone Number	:	724-226-8711
Fax Number	:	724-226-0555

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	03/20/2015

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