| Doctor Name: | LAURA HAZELTINE |
| NPI Number: | 1164553343 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 25775 |
| Business Practice Address: | 115 Wallen Dr Van Lear, KY - 412659045 |
| Business Phone Number: | 6067937953 |
| Business Fax Number: | |
| Mailing Address: | 115 Wallen Dr, VAN LEAR |
| State: | KY |
| Postal Code: | 412659045 |
| Phone Number: | 6067937953 |
| Fax Number: | |
| NPI Enumeration Date: | 03/08/2007 |
| NPI Last Update Date: | 06/01/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 25775 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |