Provider Demographics
NPI:1285673392
Name:HAZLETT, CHRISTINE L (PA)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:L
Last Name:HAZLETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:HAZLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4101 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-7588
Mailing Address - Country:US
Mailing Address - Phone:785-587-4101
Mailing Address - Fax:
Practice Address - Street 1:4101 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7588
Practice Address - Country:US
Practice Address - Phone:785-587-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500783363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100405680AMedicaid
KS042788Medicare ID - Type Unspecified
KS100405680AMedicaid