Provider Demographics
NPI:1366816639
Name:SANTOS, HAZEL (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:HAZEL
Middle Name:
Last Name:SANTOS
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 WILDCAT CLIFFS LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2964
Mailing Address - Country:US
Mailing Address - Phone:404-429-3216
Mailing Address - Fax:
Practice Address - Street 1:2208 WILDCAT CLIFFS LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-2964
Practice Address - Country:US
Practice Address - Phone:404-429-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA157236163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse