Provider Demographics
NPI:1598429052
Name:HAZEN, MARIAH (NP)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:HAZEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48072
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28331-8072
Mailing Address - Country:US
Mailing Address - Phone:910-580-8195
Mailing Address - Fax:910-828-2934
Practice Address - Street 1:823 ELM ST STE 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4164
Practice Address - Country:US
Practice Address - Phone:910-580-8195
Practice Address - Fax:318-906-4613
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200446363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health