Provider Demographics
NPI:1851751804
Name:CHRISTMAS, MAHULIE HAZLE
Entity Type:Individual
Prefix:
First Name:MAHULIE
Middle Name:HAZLE
Last Name:CHRISTMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 EDISON
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206
Mailing Address - Country:US
Mailing Address - Phone:313-209-1315
Mailing Address - Fax:
Practice Address - Street 1:1709 EDISON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2073
Practice Address - Country:US
Practice Address - Phone:313-209-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC623575298712247000000X, 247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information