Provider Demographics
NPI:1922242262
Name:HAZELWOOD, CYNTHIA DUKE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DUKE
Last Name:HAZELWOOD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:LYNN
Other - Last Name:DUKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:2561 S 1560 W
Mailing Address - Street 2:STE B
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84087-2361
Mailing Address - Country:US
Mailing Address - Phone:801-505-0821
Mailing Address - Fax:801-505-0803
Practice Address - Street 1:6781 N 2100 E
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:UT
Practice Address - Zip Code:84310-4701
Practice Address - Country:US
Practice Address - Phone:435-770-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT277575-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT277575-4405OtherLICENSE
UT277575-4405OtherLICENSE