Provider Demographics
NPI:1083228092
Name:HAZEMAN, KRISTIN DENEILLE (DNP, APRN, CNM)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DENEILLE
Last Name:HAZEMAN
Suffix:
Gender:F
Credentials:DNP, APRN, CNM
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:DENEILLE
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19170 JASPER ST NW
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-9639
Mailing Address - Country:US
Mailing Address - Phone:612-867-7331
Mailing Address - Fax:
Practice Address - Street 1:1001 HART BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8929
Practice Address - Country:US
Practice Address - Phone:763-295-2921
Practice Address - Fax:763-581-9090
Is Sole Proprietor?:No
Enumeration Date:2020-09-07
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN204419-0163WX0002X
MN591367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN204419-0OtherREGISTERED NURSING LICENSE
MNCNM09522OtherCERTIFIED NURSE MIDWIFE
MN591OtherAPRN LICENSE