Provider Demographics
NPI:1164293973
Name:ABUAITA, HAZAR
Entity Type:Individual
Prefix:
First Name:HAZAR
Middle Name:
Last Name:ABUAITA
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 1:8341 GROVEMONT CT
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1967
Mailing Address - Country:US
Mailing Address - Phone:810-610-6940
Mailing Address - Fax:
Practice Address - Street 1:8341 GROVEMONT CT
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1967
Practice Address - Country:US
Practice Address - Phone:810-610-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704355106363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner