Provider Demographics
NPI:1427689637
Name:HAZER, GRETA (LAC)
Entity type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:HAZER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 FORD PKWY APT 204
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1936
Mailing Address - Country:US
Mailing Address - Phone:612-702-2265
Mailing Address - Fax:
Practice Address - Street 1:4201 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-4728
Practice Address - Country:US
Practice Address - Phone:952-933-8900
Practice Address - Fax:952-945-9536
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1938171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty