MEDICARE: JESSICA HAZELBAKER-BUELL DEM

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	175M00000X	Lay Midwife

General Provider Information

NPI Number	:	1598213860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HAZELBAKER-BUELL DEM

Provider Business Mailing Address
First Line	:	5115 OLENTANGY RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-3413
Country	:	US
Telephone Number	:	740-936-7415
Fax Number	:	614-326-3509

Provider Business Practice Location Address
First Line	:	5115 OLENTANGY RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-3413
Country	:	US
Telephone Number	:	740-936-7415
Fax Number	:	614-326-3509

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

Provider Enumeration Date	:	09/15/2016
Last Update Date	:	09/15/2016

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