Provider Demographics
NPI:1730426073
Name:OUTRAM-EVANS, HAZELINE CLAUDIA
Entity type:Individual
Prefix:MS
First Name:HAZELINE
Middle Name:CLAUDIA
Last Name:OUTRAM-EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HAZELINE
Other - Middle Name:CLAUDIA
Other - Last Name:OUTRAMWEEKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,ANP,PNP
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:LANE
Mailing Address - State:SC
Mailing Address - Zip Code:29564-0130
Mailing Address - Country:US
Mailing Address - Phone:843-615-7320
Mailing Address - Fax:
Practice Address - Street 1:11 OAK HILL LOOP
Practice Address - Street 2:
Practice Address - City:GREELEYVILLE
Practice Address - State:SC
Practice Address - Zip Code:29056-0130
Practice Address - Country:US
Practice Address - Phone:843-615-7320
Practice Address - Fax:843-408-0308
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207924163W00000X
NY396113-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse