Provider Demographics
NPI:1982632246
Name:HAZLE, NANCY RUTH (CNM)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:RUTH
Last Name:HAZLE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WALNUT ST
Mailing Address - Street 2:14TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5109
Mailing Address - Country:US
Mailing Address - Phone:215-829-8000
Mailing Address - Fax:215-829-8623
Practice Address - Street 1:800 WALNUT ST
Practice Address - Street 2:14TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5109
Practice Address - Country:US
Practice Address - Phone:215-829-8000
Practice Address - Fax:215-829-8623
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008403L176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1552822Medicaid
PA557731OtherUSHC PROFESSIONAL
PA5160420OtherAETNA PPO
PA882567OtherBLUE CROSS PPO
PA3504896OtherAETNA FACILITY HMO 1307
PAP003421OtherCHAMPUS
PA19394000OtherBLUE CROSS - HMO
PA882567OtherKEYSTONE PROFESSIONAL
PA23-2080862OtherPRUDENTIAL
PA01552822-09OtherAMERICHOICE (MA)
PA6475804OtherCIGNA
PA882567OtherBLUE SHIELD PROFESSIONAL
PA882567OtherPERSONAL CHOICE PROF
PA9008285OtherPRIVATE HEALTHCARE