Provider Demographics
NPI:1639798465
Name:BATTLE, HAZEL (LPN)
Entity Type:Individual
Prefix:MRS
First Name:HAZEL
Middle Name:
Last Name:BATTLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13805 VILLAGE MILL DR STE 203
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4304
Mailing Address - Country:US
Mailing Address - Phone:804-794-6290
Mailing Address - Fax:804-378-6156
Practice Address - Street 1:13805 VILLAGE MILL DR STE 203
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4304
Practice Address - Country:US
Practice Address - Phone:804-794-6290
Practice Address - Fax:804-378-6156
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-12
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002099013164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1201Medicaid