Provider Demographics
NPI:1235487612
Name:HAZEL, TAMELA SUE (RN)
Entity Type:Individual
Prefix:
First Name:TAMELA
Middle Name:SUE
Last Name:HAZEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 E HILL DR
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5618
Mailing Address - Country:US
Mailing Address - Phone:608-444-2319
Mailing Address - Fax:
Practice Address - Street 1:2403 E HILL DR
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5618
Practice Address - Country:US
Practice Address - Phone:608-444-2319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI141615-030163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine