Provider Demographics
NPI:1437319563
Name:DAY, HAZEL (IP)
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:
Last Name:DAY
Suffix:
Gender:F
Credentials:IP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2648 RUNWAY AVE
Mailing Address - Street 2:APT B
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106
Mailing Address - Country:US
Mailing Address - Phone:513-734-3233
Mailing Address - Fax:
Practice Address - Street 1:2648 RUNWAY AVE
Practice Address - Street 2:APT B
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106
Practice Address - Country:US
Practice Address - Phone:513-734-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2747031374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2747031Medicaid