Provider Demographics
NPI:1841464435
Name:FUGATE, HAZEL HANSEN (RRT)
Entity type:Individual
Prefix:
First Name:HAZEL
Middle Name:HANSEN
Last Name:FUGATE
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 OXLEY BR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1193
Mailing Address - Country:US
Mailing Address - Phone:606-784-8896
Mailing Address - Fax:
Practice Address - Street 1:529 OXLEY BR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1193
Practice Address - Country:US
Practice Address - Phone:606-784-8896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48812279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care