Provider Demographics
NPI:1881837508
Name:HATFIELD, CAROLYN SUE (MLT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SUE
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:MLT
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:SUE
Other - Last Name:HARSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MLT
Mailing Address - Street 1:RR 1 BOX 67
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:MT
Mailing Address - Zip Code:59526-9705
Mailing Address - Country:US
Mailing Address - Phone:406-353-3100
Mailing Address - Fax:406-353-3229
Practice Address - Street 1:RR 1 BOX 67
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:MT
Practice Address - Zip Code:59526-9705
Practice Address - Country:US
Practice Address - Phone:406-353-3100
Practice Address - Fax:406-353-3229
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN57855246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN57855OtherLICENSE