Provider Demographics
NPI:1619043742
Name:HAZEL, KATHLEEN M (NP CNM MSN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:HAZEL
Suffix:
Gender:F
Credentials:NP CNM MSN
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:WHALEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, MSN
Mailing Address - Street 1:80 SEYMOUR STREET
Mailing Address - Street 2:HARTFORD HOSPITAL OB/GYN DEPT
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06102-5037
Mailing Address - Country:US
Mailing Address - Phone:860-972-2780
Mailing Address - Fax:
Practice Address - Street 1:80 SEYMOUR STREET
Practice Address - Street 2:HARTFORD HOSPITAL OB/GYN DEPT
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06102
Practice Address - Country:US
Practice Address - Phone:860-972-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-420766-1207V00000X, 363LW0102X
NYF420766-1207VG0400X, 363L00000X
CT003737367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00362863Medicaid
CT000379OtherCT MIDWIFE LICENSE
TN140082OtherRN
TN16805OtherAPN LICENSE- MIDWIFE
CT379OtherMIDWIFE LICENSE
NYF-420766-1OtherLICENSE
NY02914276Medicaid