Provider Demographics
NPI:1124877717
Name:AGUILAR, HAZELINE AMOREANNA (HM 60870744)
Entity type:Individual
Prefix:
First Name:HAZELINE
Middle Name:AMOREANNA
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:HM 60870744
Other - Prefix:
Other - First Name:ELVIRA
Other - Middle Name:
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HM 60870744
Mailing Address - Street 1:120 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2513
Mailing Address - Country:US
Mailing Address - Phone:509-630-3630
Mailing Address - Fax:
Practice Address - Street 1:607 SW GRADY WAY STE 110
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2977
Practice Address - Country:US
Practice Address - Phone:425-330-2061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHM60870744374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide