Provider Demographics
NPI:1225042658
Name:HAZARD, MARY DARLENE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:DARLENE
Last Name:HAZARD
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:1201 MONTLIMAR DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1718
Mailing Address - Country:US
Mailing Address - Phone:251-343-0989
Mailing Address - Fax:251-343-0792
Practice Address - Street 1:7286 BUTTERFLY CIR
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-4040
Practice Address - Country:US
Practice Address - Phone:251-509-5347
Practice Address - Fax:479-201-0668
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2016-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL1-056988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51093024OtherBCBS OF AL
AL51093024OtherBCBS OF AL
ALS98530Medicare UPIN