Provider Demographics
NPI:1851693725
Name:DILLEHAY, HAZEL (RN)
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:
Last Name:DILLEHAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 ALBERT PIKE RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-4011
Mailing Address - Country:US
Mailing Address - Phone:501-624-6557
Mailing Address - Fax:501-624-1481
Practice Address - Street 1:1910 ALBERT PIKE RD
Practice Address - Street 2:SUITE H
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4011
Practice Address - Country:US
Practice Address - Phone:501-624-6557
Practice Address - Fax:501-624-1481
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR53953332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR118760716Medicaid