Provider Demographics
NPI:1801663133
Name:HAZEN, EMMA K (NP)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:K
Last Name:HAZEN
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 1:192 WEST ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2637
Mailing Address - Country:US
Mailing Address - Phone:508-361-3966
Mailing Address - Fax:
Practice Address - Street 1:110 LOCKWOOD ST FL 6
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4801
Practice Address - Country:US
Practice Address - Phone:401-793-9166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN59052163W00000X
RIAPRN03913363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse