Provider Demographics
NPI:1134540198
Name:HAZELRIG, CASSANDRA (DNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:HAZELRIG
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4932 WUNNENBERG WAY STE B
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-4985
Mailing Address - Country:US
Mailing Address - Phone:513-862-3200
Mailing Address - Fax:135-682-3201
Practice Address - Street 1:4932 WUNNENBERG WAY STE B
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4985
Practice Address - Country:US
Practice Address - Phone:513-682-3200
Practice Address - Fax:513-682-3201
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.15458363LP0808X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health