Individual
MARIANNE HAZELITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
5320 S RAINBOW BLVD STE 150, LAS VEGAS, NV 89118-1807
(702) 944-7105
(702) 944-7110
Mailing address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
(702) 216-3346
(702) 671-6883
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DO2191
NV
207R00000X
Internal Medicine Physician
UO2769
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558655027
—
NV
01
—
DO2191
STATE LICENSE
NV
Enumeration date
06/02/2011
Last updated
08/18/2023
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