Provider Demographics
NPI:1598213860
Name:HAZELBAKER-BUELL, JESSICA (DEM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HAZELBAKER-BUELL
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 OLENTANGY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-3413
Mailing Address - Country:US
Mailing Address - Phone:740-936-7415
Mailing Address - Fax:614-326-3509
Practice Address - Street 1:5115 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-3413
Practice Address - Country:US
Practice Address - Phone:740-936-7415
Practice Address - Fax:614-326-3509
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay