Provider Demographics
NPI:1154164101
Name:HASTEN, NICHOLAS
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:HASTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MORNING DAWN LN
Mailing Address - Street 2:
Mailing Address - City:ANDICE
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3733
Mailing Address - Country:US
Mailing Address - Phone:512-527-4560
Mailing Address - Fax:
Practice Address - Street 1:120 MORNING DAWN LN
Practice Address - Street 2:
Practice Address - City:ANDICE
Practice Address - State:TX
Practice Address - Zip Code:78628-3733
Practice Address - Country:US
Practice Address - Phone:512-527-4560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health