Provider Demographics
NPI:1700393139
Name:HAZELETT, KATELYN MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:MARIE
Last Name:HAZELETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 N NAPER BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8831
Mailing Address - Country:US
Mailing Address - Phone:815-212-4079
Mailing Address - Fax:630-428-4188
Practice Address - Street 1:1804 N NAPER BLVD STE 103
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8831
Practice Address - Country:US
Practice Address - Phone:815-212-4079
Practice Address - Fax:630-428-4188
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016822363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner