Provider Demographics
NPI:1366418576
Name:HAZARD, STEPHANIE SUSAN (CRNA)
Entity type:Individual
Prefix:PROF
First Name:STEPHANIE
Middle Name:SUSAN
Last Name:HAZARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH VERSAILLES
Mailing Address - State:PA
Mailing Address - Zip Code:15137-2510
Mailing Address - Country:US
Mailing Address - Phone:412-641-4260
Mailing Address - Fax:
Practice Address - Street 1:1700 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:NORTH VERSAILLES
Practice Address - State:PA
Practice Address - Zip Code:15137-2510
Practice Address - Country:US
Practice Address - Phone:412-641-4260
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN148619L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS68472Medicare UPIN
PA022058FEVMedicare ID - Type Unspecified