Provider Demographics
NPI:1003026832
Name:HAZLIP, CARMEN (LPN)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:HAZLIP
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3584 GOLDEN MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1437
Mailing Address - Country:US
Mailing Address - Phone:937-559-3438
Mailing Address - Fax:
Practice Address - Street 1:3584 GOLDEN MEADOWS CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1437
Practice Address - Country:US
Practice Address - Phone:937-559-3438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN112202164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse