Provider Demographics
NPI:1255304002
Name:HAZLETT, NEDRA (CRNP)
Entity Type:Individual
Prefix:
First Name:NEDRA
Middle Name:
Last Name:HAZLETT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2104
Mailing Address - Country:US
Mailing Address - Phone:724-226-8711
Mailing Address - Fax:724-226-0555
Practice Address - Street 1:1709 UNION AVE
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2104
Practice Address - Country:US
Practice Address - Phone:724-226-8711
Practice Address - Fax:724-226-0555
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN193623L363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022574090001Medicaid
PA1022574090001Medicaid
PAP53887Medicare UPIN