MEDICARE: IVADEAN HATFIELD

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	PN072417	OH

General Provider Information

NPI Number	:	1265988232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVADEAN HATFIELD

Provider Business Mailing Address
First Line	:	566 BUTLER RD N
Second Line	:
City	:	NEW LONDON
State	:	OH
Zip	:	44851-9002
Country	:	US
Telephone Number	:	419-929-0746
Fax Number	:

Provider Business Practice Location Address
First Line	:	566 BUTLER RD N
Second Line	:
City	:	NEW LONDON
State	:	OH
Zip	:	44851-9002
Country	:	US
Telephone Number	:	419-929-0746
Fax Number	:

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

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	08/30/2016

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Directions to “ IVADEAN HATFIELD ” Practice Location

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