Provider Demographics
NPI:1649463100
Name:HAZLE, NANCY CLAYCOMB (MA)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:CLAYCOMB
Last Name:HAZLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 DOGWOOD PL
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2189
Mailing Address - Country:US
Mailing Address - Phone:270-765-5693
Mailing Address - Fax:270-769-1540
Practice Address - Street 1:805 DOGWOOD PL
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2189
Practice Address - Country:US
Practice Address - Phone:270-765-5693
Practice Address - Fax:270-769-1540
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator