Provider Demographics
NPI:1164007241
Name:HAZLEWOOD, ELIZABETH CATHERINE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CATHERINE
Last Name:HAZLEWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1414
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1414
Mailing Address - Country:US
Mailing Address - Phone:458-217-3040
Mailing Address - Fax:855-962-2388
Practice Address - Street 1:250 NW 1ST ST STE B&C
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4836
Practice Address - Country:US
Practice Address - Phone:458-217-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000104462172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker