Provider Demographics
NPI:1740542794
Name:BALLINA, HAZLE COURTNEY (APRN)
Entity type:Individual
Prefix:DR
First Name:HAZLE
Middle Name:COURTNEY
Last Name:BALLINA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:H.
Other - Middle Name:COURTNEY
Other - Last Name:BALLINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APNP
Mailing Address - Street 1:1283 BLUE JAY PL
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-2586
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1480 10TH AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-9342
Practice Address - Country:US
Practice Address - Phone:715-544-7446
Practice Address - Fax:651-412-7599
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-207943-7363LF0000X
WI6332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily