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Individual

JOHNNY MALCOLM HASSERODT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
13725 NORTHWEST BLVD STE 260, CORPUS CHRISTI, TX 78410-5123
(361) 387-5161
Mailing address
PO BOX 261017, CORPUS CHRISTI, TX 78426-1017
(361) 387-5161

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
674744
TX

Other

Enumeration date
06/08/2011
Last updated
08/03/2016
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