Provider Demographics
NPI:1740243344
Name:HAZEL, SUSANNE (NP)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:HAZEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JOHN JAMES AUDUBON PKWY FL 2
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1145
Mailing Address - Country:US
Mailing Address - Phone:716-849-8750
Mailing Address - Fax:716-849-8756
Practice Address - Street 1:1 JOHN JAMES AUDUBON PKWY FL 2
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228
Practice Address - Country:US
Practice Address - Phone:716-849-8750
Practice Address - Fax:716-849-8756
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM63373363L00000X
NY332652363L00000X
NV838613363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026762505OtherUNIVERA
NY9512581OtherIND. HEALTH
NY00026516801OtherUNIVERA
NY000560496003OtherBLUE CROSS
NY000560496007OtherBCBS
NY02160236Medicaid
NY00026516801OtherUNIVERA
NYCC7148Medicare PIN
P35945Medicare UPIN