Provider Demographics
NPI:1265988232
Name:HATFIELD, IVADEAN
Entity type:Individual
Prefix:
First Name:IVADEAN
Middle Name:
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 BUTLER RD N
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:44851-9002
Mailing Address - Country:US
Mailing Address - Phone:419-929-0746
Mailing Address - Fax:
Practice Address - Street 1:566 BUTLER RD N
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:OH
Practice Address - Zip Code:44851-9002
Practice Address - Country:US
Practice Address - Phone:419-929-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN072417164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse