Provider Demographics
NPI:1649543349
Name:HAZDRA, ASHLEY
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:HAZDRA
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 1:2077 NE HOLLIDAY AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6003
Mailing Address - Country:US
Mailing Address - Phone:541-598-5440
Mailing Address - Fax:
Practice Address - Street 1:780 NW YORK DR
Practice Address - Street 2:202
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1053
Practice Address - Country:US
Practice Address - Phone:541-598-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-12
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC156088171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist