Doctor Name: | JENNIFER LOUISE HAZARD |
NPI Number: | 1578902839 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CNP |
License Number: | 209010486 |
Business Practice Address: | 603 W Mondamin St Minooka, IL - 604479057 |
Business Phone Number: | 8155211010 |
Business Fax Number: | 8155211826 |
Mailing Address: | 603 W Mondamin St, MINOOKA |
State: | IL |
Postal Code: | 604479057 |
Phone Number: | 8155211010 |
Fax Number: | |
NPI Enumeration Date: | 06/20/2013 |
NPI Last Update Date: | 08/07/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209010486 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |