Provider Demographics
NPI:1073810172
Name:HEZLEP, NORMAN M (RNFA)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:M
Last Name:HEZLEP
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23423 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-9211
Mailing Address - Country:US
Mailing Address - Phone:574-273-5218
Mailing Address - Fax:
Practice Address - Street 1:23423 ADAMS RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-9211
Practice Address - Country:US
Practice Address - Phone:574-273-5218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28150524A163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant