Provider Demographics
NPI:1285399196
Name:HATTERSLEY, AIDAN
Entity type:Individual
Prefix:
First Name:AIDAN
Middle Name:
Last Name:HATTERSLEY
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 1:4378 AUBURN BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-4175
Mailing Address - Country:US
Mailing Address - Phone:279-348-7200
Mailing Address - Fax:279-348-7201
Practice Address - Street 1:4378 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4175
Practice Address - Country:US
Practice Address - Phone:279-348-7200
Practice Address - Fax:279-348-7201
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator