MEDICARE: NANCY HAZEN

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	106H00000X	Marriage & Family Therapist	0414	NM

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
2	00JD84	OTHER	NM	BCBS PROVIDER NUMBER
3	NM102165	OTHER	NM	VALUE OPTIONS PROVIDER #

General Provider Information

NPI Number	:	1952310435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY HAZEN

Provider Business Mailing Address
First Line	:	HC 74 BOX 20709
Second Line	:
City	:	EL PRADO
State	:	NM
Zip	:	87529-9507
Country	:	US
Telephone Number	:	505-758-1494
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 RIO LUCERO RD
Second Line	:
City	:	EL PRADO
State	:	NM
Zip	:	87529-9507
Country	:	US
Telephone Number	:	505-758-1494
Fax Number	:

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/09/2007

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Directions to “ NANCY HAZEN ” Practice Location

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