Provider Demographics
NPI:1003562356
Name:HAZELEY, JOSEPHINE WINIFRED (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:WINIFRED
Last Name:HAZELEY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 LONGLEAF PINE PL
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7833
Mailing Address - Country:US
Mailing Address - Phone:919-730-3785
Mailing Address - Fax:
Practice Address - Street 1:1415 NC-54 SUITE 105
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707
Practice Address - Country:US
Practice Address - Phone:919-275-1405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAZE-S67UD363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health