Provider Demographics
NPI:1205560299
Name:HAZLETT, EMILY RUTH
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RUTH
Last Name:HAZLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CHANDLER DR APT B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6078
Mailing Address - Country:US
Mailing Address - Phone:814-920-0560
Mailing Address - Fax:
Practice Address - Street 1:120 CHANDLER DR APT B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6078
Practice Address - Country:US
Practice Address - Phone:814-920-0560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant