Provider Demographics
NPI:1407980733
Name:HAZEN, NATALIE JO (BS)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:JO
Last Name:HAZEN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MS
Other - First Name:NATALIE
Other - Middle Name:JO
Other - Last Name:SKARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:N6975 950TH ST
Mailing Address - Street 2:
Mailing Address - City:ELK MOUND
Mailing Address - State:WI
Mailing Address - Zip Code:54739-9388
Mailing Address - Country:US
Mailing Address - Phone:715-879-4166
Mailing Address - Fax:
Practice Address - Street 1:808 MAIN ST E
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2735
Practice Address - Country:US
Practice Address - Phone:715-232-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH250000211131171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator