Provider Demographics
NPI:1568527489
Name:HAZARD, GLORIA JEAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:JEAN
Last Name:HAZARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:GLORIA
Other - Middle Name:JEAN
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 E HOSPITAL LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4230
Mailing Address - Country:US
Mailing Address - Phone:812-234-0707
Mailing Address - Fax:812-234-3352
Practice Address - Street 1:501 E HOSPITAL LN
Practice Address - Street 2:SUITE 101
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4230
Practice Address - Country:US
Practice Address - Phone:812-234-0707
Practice Address - Fax:812-234-3352
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27054323A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse