Provider Demographics
NPI:1720614597
Name:HAZELTON, ANDREA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:HAZELTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PIONEERS MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MEEKER
Mailing Address - State:CO
Mailing Address - Zip Code:81641-3181
Mailing Address - Country:US
Mailing Address - Phone:970-878-4014
Mailing Address - Fax:
Practice Address - Street 1:100 PIONEERS MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MEEKER
Practice Address - State:CO
Practice Address - Zip Code:81641-3181
Practice Address - Country:US
Practice Address - Phone:970-878-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995969-NP363LF0000X
CO0200549163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse