Basic Information
| Provider Information | |||||||||
| NPI: | 1841493301 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAZEL | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 187 LOVE AVE | ||||||||
| Address2: | APT. G | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461425193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175173877 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8060 KNUE RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462501976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178427435 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 27055770A | IN | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.