1982632246 NPI number — NANCY RUTH HAZLE CNM

Table of content: NANCY RUTH HAZLE CNM (NPI 1982632246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982632246 NPI number — NANCY RUTH HAZLE CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAZLE
Provider First Name:
NANCY
Provider Middle Name:
RUTH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982632246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 WALNUT ST
Provider Second Line Business Mailing Address:
14TH FLOOR
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-5109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-829-8000
Provider Business Mailing Address Fax Number:
215-829-8623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 WALNUT ST
Provider Second Line Business Practice Location Address:
14TH FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-5109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-829-8000
Provider Business Practice Location Address Fax Number:
215-829-8623
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 176B00000X , with the licence number:  MW008403L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1552822 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 557731 . This is a "USHC PROFESSIONAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5160420 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 882567 . This is a "BLUE CROSS PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3504896 . This is a "AETNA FACILITY HMO 1307" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P003421 . This is a "CHAMPUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 19394000 . This is a "BLUE CROSS - HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 882567 . This is a "KEYSTONE PROFESSIONAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 23-2080862 . This is a "PRUDENTIAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01552822-09 . This is a "AMERICHOICE (MA)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6475804 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 882567 . This is a "BLUE SHIELD PROFESSIONAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 882567 . This is a "PERSONAL CHOICE PROF" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9008285 . This is a "PRIVATE HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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