Provider Demographics
NPI:1417559287
Name:HAZLY, JIBREEL N
Entity Type:Individual
Prefix:
First Name:JIBREEL
Middle Name:N
Last Name:HAZLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 STANWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-1234
Mailing Address - Country:US
Mailing Address - Phone:330-618-5246
Mailing Address - Fax:
Practice Address - Street 1:953 STANWOOD AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-1234
Practice Address - Country:US
Practice Address - Phone:330-618-5246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide