Provider Demographics
NPI:1861718876
Name:REEL, HAZEL LOUISE (ARNP)
Entity type:Individual
Prefix:
First Name:HAZEL
Middle Name:LOUISE
Last Name:REEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 S DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-7013
Mailing Address - Country:US
Mailing Address - Phone:918-485-9696
Mailing Address - Fax:918-485-1701
Practice Address - Street 1:1317 S DEWEY AVE
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-7013
Practice Address - Country:US
Practice Address - Phone:918-485-9696
Practice Address - Fax:918-485-1701
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0049114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK352276246OtherTAX ID