Provider Demographics
NPI:1518651256
Name:HATCH, CHRISLEIGH ANN OLGA FALEIRO
Entity type:Individual
Prefix:
First Name:CHRISLEIGH
Middle Name:ANN OLGA FALEIRO
Last Name:HATCH
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 1:520 HANDEYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-1277
Mailing Address - Country:US
Mailing Address - Phone:415-819-2941
Mailing Address - Fax:
Practice Address - Street 1:520 HANDEYSIDE LN
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1277
Practice Address - Country:US
Practice Address - Phone:415-819-2941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI6001271-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program