Provider Demographics
NPI:1164584652
Name:HAZELTON, JULIE L (NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:L
Last Name:HAZELTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:L
Other - Last Name:BAITHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 911
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-0911
Mailing Address - Country:US
Mailing Address - Phone:207-303-3300
Mailing Address - Fax:207-250-2140
Practice Address - Street 1:2 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6078
Practice Address - Country:US
Practice Address - Phone:207-303-3300
Practice Address - Fax:207-250-2144
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER033263363LF0000X
MECNP81556363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001011703Medicare PIN